CARDIAC

ARREST
By
Gamal faheim, MD
Associate professor of cardiovascular
medicine

DEFINITIONS
CARDIAC ARREST: Abrupt
cessation of cardiac pump function
which may be reversible by a rapid
intervention but will lead to death
in its absence.
DEATH: Irreversible cessation of all
biologic functions

MECHANISMS OF CARDIAC
ARREST
50-80%:
20-30%:

VF and PULSLESS VT

Asystole, severe
bradycardia and pulseless
electrical activity

Background

USA - 250 000 to 330000 estimated

annual SCA deaths per year
Survival < 6% worldwide average
Trials - short term outcomes
- underpowered, small
- not randomized
- design limitations
Informed consent

Decision to start CPR:

Decision to start CPR is made if a victim is

unresponsive and not breathing normally.

Pulse check is no longer required, and is

NOT recommended for lay persons.

Pulse check has been shown to be

unreliable, with unacceptably high rates of
false positives and negatives.
7

Cardio-pulmonary resuscitation
(CPR) is a means to provide
temporary support to the
coronary and cerebral
circulation, till normal cardiac
output is restored

Adult Basic Life Support

PERSON
COLLAPSES
Check if he is
unresponsive.
Call Emergency
number.
Get AED (automatic
Electric Defibrillator)
Begin the ABCDs

Adult Basic Life Support

Basic life support consists of the following sequence of actions:

Make sure the victim, any bystanders, and you are safe.
Check the victim for a response.
Gently shake his shoulders and ask loudly, Are you all right?
If he responds:

Leave him in the position in which you find him provided there is
no further danger.

Try to find out what is wrong with him and get help if needed.

Reassess him regularly.

If he does not respond:

Shout for help.

Turn the victim supine aligned position or stable side position.

CONFIRM LOSS OF
CONSCIOUSNESS

Shout

Loudly!
Shake Gently!!

Adult Basic Life Support

START THE ABCDs
Airway: Open Airway.
Breathing:

Check Breathing

(Look, Listen &Feel)

Breathing
Non Breathing

Check Circulation
Circulation:.
Monitor and check
Circulation
the pulse.
Arrest

Adult Basic Life Support

Defibrillator:
An important advance in
providing BLS is the
availability of AED, which
can be used to deliver
defibrillation. improving
survival outcomes in
cardiac arrest cases.

Open airway signs of

life?

Head tilt / chin lift

Check breathing and
pulse for 10 sec
If no breathing & no
pulse or unsure of
pulse assume
cardiac arrest
Caution of agonal
breathing

Adult Basic Life Support

Breathing:
Keeping the airway open, look, listen, and feel for normal breathing.
Look for chest movement.
Listen at the victim's mouth for breath sounds.
Feel for air on your cheek.
In the first few minutes after cardiac arrest, a victim may be barely
breathing, taking infrequent, noisy, gasps. Do not confuse this with
normal breathing.
Look, listen, and feel for no more than 10 sec to determine if the victim
is breathing normally. If you have any doubt whether breathing is
normal, act as if it is not normal.

Pocket mask vs bag-valve

mask

If signs of life present

Signs of life...
Normal breathing
Coughing
Movement
Palpable pulse

Assess ABCDE
Call expert help
immediately

Adult Basic Life Support

If he is breathing normally:

Turn him into the recovery position.

Send or go for help, or call for an ambulance.
Check for continued breathing.

If he is not breathing normally:

Ask someone to call for an ambulance or, if you are
on your own, do this yourself; you may need to leave
the victim.
Start chest compression as follows:

Kneel by the side of the victim.

Place the heel of one hand in the centre of the victims chest.

Adult Basic Life Support

Place the heel of your other hand on top of the first hand.
Interlock the fingers of your hands and ensure that pressure is

not applied over the victim's ribs. Do not apply any pressure
over the upper abdomen or the bottom end of the bony
sternum (breastbone).

Position yourself vertically above the victim's chest and, with

your arms straight, press down on the sternum 4 - 5 cm.

After each compression, release all the pressure on the chest

without losing contact between your hands and the sternum.

Repeat at a rate of about 100 times a minute (a little less than

2 compressions a second).

Compression and release should take an equal amount of time.

Chest compressions

Place hands on the center of the chest,

rather than the rib margin method.

100/min for all victims (except newborns).

Allow chest to recoil to normal position after

each compression.

Use equal compression and relaxation times.

Limit interruptions in chest compressions,

even for rhythm check, shock delivery,
advanced airway, or vascular access.
20

30 chest compressions

Heel of hand in
centre of chest
Interlock fingers
Keep arms straight
Compress 4-5 cm
depth
Rate of 100 min-1
Allow chest to recoil

Adult Basic Life Support

Combine chest compression with rescue breaths:

After 30 compressions open the airway again using head tilt and chin
lift.
Pinch the soft part of the victims nose closed, using the index finger
and thumb of your hand on his forehead.
Allow his mouth to open, but maintain chin lift.
Take a normal breath and place your lips around his mouth, making
sure that you have a good seal.
Blow steadily into his mouth whilst watching for his chest to rise; take
about one second to make his chest rise as in normal breathing; this is
an effective rescue breath.
Maintaining head tilt and chin lift, take your mouth away from the victim
and watch for his chest to fall as air comes out.

Adult Basic Life Support

Take another normal breath and blow into the

victims mouth once more to give a total of two
effective rescue breaths. Then return your hands
without delay to the correct position on the
sternum and give a further 30 chest
compressions.
Continue with chest compressions and rescue
breaths in a ratio of 30:2.
Stop to recheck the victim only if he starts
breathing normally; otherwise do not interrupt
resuscitation.

Adult Basic Life Support

If your rescue breaths do not make the chest rise as in

normal breathing, then before your next attempt:

Check the victim's mouth and remove any visible obstruction.

Recheck that there is adequate head tilt and chin lift.
Do not attempt more than two breaths each time before
returning to chest compressions.

If there is more than one rescuer present, another should

take over CPR about every 2 min to prevent fatigue.
Ensure the minimum of delay during the changeover of
rescuers.

Adult Basic Life Support

Chest-compression-only CPR:

If you are not able, or are unwilling, to give rescue

breaths, give chest compressions only.
If chest compressions only are given, these should
be continuous at a rate of 100 a minute.
Stop to recheck the victim only if he starts
breathing normally; otherwise do not interrupt
resuscitation.

Adult Basic Life Support

Continue resuscitation until:

Qualified help arrives and takes over,

The victim starts breathing normally, or
You become exhausted.

Adult Basic Life Support

RECOVERY POSITION

HIGH QUALITY CPR

RATE - push hard, push fast 100/min

DEPTH - 1.5 TO 2 inches

COMPLETE CHEST RECOIL

MINIMISE INTERRUPTIONS

CHANGE REGULARLY
Restore Coronary & Cerebral Blood Flow

Technique of CPR

Push Hard and Push Fast

Complete Chest Recoil

Minimal Interruptions <10s

Change Regularly

The Shocking Facts

Bundle Branch Reentrant VT

Ventricular Flutter
Spontaneous conversion to NSR (12-lead ECG)

VF with Defibrillation (12-lead ECG)

Torsades de Pointes

Spontaneous conversion to NSR

(continuous lead II monitor strip)

Wide QRS Irregular Tachycardia:

Atrial Fibrillation with antidromic conduction in

patient with accessory pathway Not VT

ECG shows negative effect of

delaying chest compressions after
shock delivery.
(From an AED record).

AED was turned on and attached.

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Shock is advised and delivered, 22 sec after pads were

attached.
38
The shock eliminates the VF;
the initial post-shock

Post-shock rhythm through the next 21 sec. Asystole is

present, and the AED is analyzing the rhythm so no CPR
39
is provided and there is no blood
flow.

 Re-fibrillation 25 sec after the first shock eliminated VF.

No CPR performed during the 25 sec.
AED then analyzes rhythm and recommends shock.
Shock is delivered, asystole follows, and the AED then
analyzes those rhythms.
CPR is finally recommended and begins a total of
40
1:17 min after the first shock.

41

Than
k
You