critical care medicine
Cardiac Arrest
Treatment of Cardiac Arrest
High-quality CPR Rapid defibrillation for shockable rhythms ( Ventricular Fibrillation (VF) [VF] or Early administration ofepinephrinefor nonshockable rhythms When possible, treatment of primary cause Postresuscitative care Rapid intervention is essential. (See also the 2020 American Heart Association [AHA]guidelinesfor CPR and emergency cardiovascular care and2022 AHA Interim Guidanceto Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19.) Cardiopulmonary resuscitation ( Cardiopulmonary Resuscitation (CPR) in Adults ) is an organized, sequential response to cardiac arrest; rapid initiation of uninterrupted chest compressions ("push hard and push fast") and early defibrillation of patients who are in VF or VT (more commonly adults) are the keys to success in achieving return of spontaneous circulation (ROSC). The 2020 AHA guidelines for treatment of cardiac arrest also advise rapid administration of a first dose of In children, who most often have asphyxial causes of cardiac arrest, the presenting rhythm is typically a bradyarrhythmia followed by asystole. However, about 15 to 20% of children (particularly when cardiac arrest has not been preceded by respiratory symptoms) present with VT or VF and thus also require prompt defibrillation. The incidence of VF as the initial recorded rhythm increases in children>12 years. has been associated with improved neurologically intact survival ( Treatment references ). IV fluid (eg, 1 L 0.9% saline, whole blood, or a combination for blood loss) should be given as needed to optimize volume status. If response to IV fluid is inadequate, clinicians may give one or more vasopressor drugs (eg, After return of pulses, postresuscitative care focuses on determination and treatment of cause, stabilization and prevention of rearrest, and optimization of neurologic outcome. In addition to treatment of cause, postresuscitative care may include methods to optimize oxygenation and ventilation and rapid coronary angiography in patients who have a ST-segment elevation (STEMI). The 2020 AHA guidelines suggest delayed coronary angiography should also be considered for patients without STEMI. Current recommendations are for targeted temperature management to therapeutic normothermia < 37.5° C, although AHA 2020 guidelines still recommend a lower temperature range. Research is ongoing to determine whether targeted temperature management with controlled hypothermia (32° C to 34° C) benefit select cardiac arrest survivors ( Treatment references ). 1.Okubo M, Komukai S, Callaway CW, Izawa J: Association of Timing ofEpinephrineAdministration With Outcomes in Adults With Out-of-Hospital Cardiac Arrest.JAMA Netw Open2021;4(8):e2120176. Published 2021 Aug 2. doi:10.1001/jamanetworkopen.2021.20176 2.Perkins GD, Ji C, Deakin CD, et al: A Randomized Trial ofEpinephrinein Out-of-Hospital Cardiac Arrest.N Engl J Med379(8):711-721, 2018. doi:10.1056/NEJMoa1806842 3.Wyckoff MH, Greif R, Morley PT, et al: 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.Circulation2022;146(25):e483–e557, 2022. doi:10.1161/CIR.0000000000001095 