CARDIAC ARREST

ETIOLOGI
most often caused by heart disease
Heart attack
Congestive heart failure, aortic stenosis
Cardiomyopati (95%) : heart muscle does
not contract properly -> iskemi
Myocarditis

Pulmonary emboli
Young: hypertropic cardiomyopati
(ventrikel >) and anomalous coronary
arteries

ETIOLOGY FREQUENCY
Coronary Artery Disease

Approximately 80%

Acute Coronary Syndrome

Chronic Myocardial Scar
Cardiomyopathie
Dilated Cardiomyopathies

Approximately
10% to 15%

Hypertrophic Cardiomyopathies
Uncommon Causes
< 5%
Valvular/Congenital Heart
Disease
Contributing Causes Of Cardiac Arrest
Myocarditis, Genetic Ion-Channel
6H
5T
Abnormalities, etc.
Hypovolemia
Toxins
Hypoxia
Tamponade, cardiac
Hydrogen ion (acidosis)
Tension, pneumothorax
Hypokalemia/Hyperkalemia
Thrombosis (coronary or
Hypothermia
pulmonary)
Hypoglycemia
Trauma

symptomp
the heart stops beating and blood is not
supplied to the body
The presentation is not subtle
immediate loss of consciousness occurs
not aroused fall over
No pulse will be able to be palpated and
no signs of breathing
pulses paradoxus, elevated jugular
venous pulsation, distant heart sounds,
and electrical alternans on ECG

Heart attack warning sign

Chest discomfort (center of the chest that lasts
more than a few minutes, or that goes away
and comes back. It can feel like uncomfortable
pressure, squeezing, fullness or pain)
Discomfort in other areas of the upper body
(one or both arms, the back, neck, jaw or
stomach)
Shortness of breath
Other signs: cold sweat, nausea or
lightheadedness

PATOFISIOLOGI

diagnosis
Sudden cardiac arrest is an
unexpected death in a person who
had no known previous diagnosis of a
fatal disease or condition. The person
may or may not have heart disease.

DIFFERENTIAL DIAGNOSIS
Acute insults (hypoxia, ischemia, acidosis,
electrolyte imbalances, and toxic effects of
certain drugs)
DRUGS:

tricyclic antidepressants
neuroleptics
macrolide and quinolone antibiotics
antifungal agents
procainamide, quinidine, disopyramide (class IA
antiarrhythmics)
sotalol, dofetilide, and ibutilide (class III
antiarrhythmics)

treatment
Do CPR !!!
Farmako: Epinephrine and atropine
IV or endotrakeal tube
Perifer >

Advanced life support: treats cardiac arrest

definitively with drugs, fluids, DC
countershock or artificial pacemaker when
appropriate
Continous of effective Basic Life Support
remains important to maintain vital organ
perfusion assure circulation of lifesaving
drugs

 ELECTRICAL PHASE: defibrillation is the

most effective
CIRCULATORY PHASE: good quality CPR
gains increasing importance along with
defibrillation
METABOLIC PHASE(global ischemic injury):
focus on metabolic derangements are
critical. Therapeutic hypothermia for
comatose survivors of SCD may assist in
neurologic recovery at this stage.

 Sodium bicarbonate (NaHCO3) and calcium

chloride (CaCl2) should never be given through
the endotracheal tube
Children as in adults defibrilation of adult/ child
receiving digoxin can result in irreversible
cardiac arrest
In such patients, defibrillation should begin with
the lowest energy setting that the defibrillator
will deliver, then cautiously increased

 Epinephrine
n a- and b-receptor agonist
increased peripheral vascular resistance via
the stimulation of a-receptors of the blood
vessels.
redistribution of blood flow from visceral
organs to the heart and brain.

Atropine
asystole and slow PEA along with epinephrine
and vasopressin

Vasopresin, amiodarone, lidocaine

PROGNOSIS
related to the frequency of coronary
artery disease.
In the adolescent population, increased
awareness of hypertrophic
cardiomyopathy and appropriate
screening may decrease the frequency of
sudden death.
Public education and widespread
availability of AEDs will increase survival.

 BAD !!
Brain death and permanent death
start to occur in just 4 to 6 minutes
after someone experiences cardiac
arrest
more than 95 percent of cardiac
arrest victims die before reaching the
hospital

Factors Associated With Improved Outcomes in Cardiac

Arrest
Presenting rhythm of VT/VF Presenting rhythm of VT/VF
Early/bystander CPR Early/bystander CPR
Early defibrillation Early defibrillation
CPR prior to defibrillation in the circulatory phase of cardiac
arrest Minimal interruptions to chest compressions
In-hospital and out-of-hospital use of AEDs
Amiodarone use in shock-resistant VT/VF
Therapeutic hypothermia in comatose cardiac arrest victims