Sudden cardiac death urgent treatment: Difference between revisions

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(New page: {{SI}} {{CMG}} ==Cardiac Arrest: Treatment== ===Out of hospital arrest=== Most out-of-hospital cardiac arrests occur following a Myocardial infarction (heart attack), and present ini...)
 
(/* 2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death {{cite journal| author=Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA | display-authors=etal| title=2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. | journal=Eur Heart J | year= 2022 | volume= 43 | issue= 40 | pages= 3997-4126 | pmid=36017572 | doi=10.1093/eurheartj/ehac26...)
 
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{{SI}}
__NOTOC__
{{Sudden cardiac death}}
{{CMG}} {{Sara.Zand}} {{EdzelCo}}
==Overview==
The mainstay of [[therapy]] for [[patients]] with [[cardiac arrest]] is starting [[cardiopulmonary resuscitation]] ([[CPR]]) with minimizing interruption in [[chest compression]]. The [[rhythm]] should be reassessed. If the [[rhythm ]]is [[ventricular fibrillation]] ([[VF]]) or [[pulseless ventricular tachycardia]] ([[VT]]), the [[shock]] should be delivered immediately. If the [[rhythm]] is [[asystole]] or [[pulseless electrical activity]] ([[PEA]]), [[CPR]] should be resumed. [[Advanced life support]] ([[ALS]]) should be kept with minimizing interruption in [[chest compression]] including:
[[advanced airway]], continuous [[chest compressions]], [[capnography]], [[intravenous]] ([[IV]]) [[intraosseous]]/ ([[IO]]) access, [[vasopressors]], and [[antiarrhythmic]] [[therapy]]. This can address  reversible causes such as [[hypoxia]], [[hypovolemia]],[[hypothermia]], [[hyperkalemia]], [[hypokalemia]],[[acidosis]], [[tension pneumothorax]], [[tamponade]], [[toxins]] ([[benzodiazepines]], [[alcohol]], [[opiates]], [[tricyclics]], [[barbiturates]], [[betablocker]]s, [[calcium channel blocker]]s), [[thrombosis]] [[ST elevation myocardial infarction]] ([[STEMI]], and massive [[pulmonary thromboembolism]]). The following should be considered immediately in [[post cardiac arrest]] [[patients]]: 12–lead [[electrocardiogram]] ([[ECG]]) ,[[perfusion]]/[[reperfusion]] in patients with [[acute myocardial infarction]],([[AMI]]), [[oxygenation]] and [[ventilation]], [[temperature]] controlling, and [[treatment]] of  reversible causes. [[Management]]  of [[patients]] in  post-cardiac arrest status include [[treatment]] of the underlying disorder, [[hemodynamic stability]], [[respiratory support]], and control of [[neurologic]] [[complications]].


{{CMG}}


==Cardiac Arrest: Treatment==
== Urgent Treatment==
===Out of hospital arrest===
Most out-of-hospital cardiac arrests occur following a [[Myocardial infarction]] (heart attack), and present initially with a heart rhythm of [[Ventricular fibrillation]]. The patient is therefore likely to be responsive to [[defibrillation]], and this has become the focus of pre-hospital interventions. Several organisations promote the idea of a "[[chain of survival]]", of which defibrillation is a key step. The links are:
* '''Early recognition''' - If possible, recognition of illness before the patient develops a cardiac arrest will allow the rescuer to prevent its occurrence. Early recognition that a cardiac arrest has occurred is key to survival - for every minute a patient is in cardiac arrest, their chances of survival drop by roughly 10% <ref name="RCUK2005">Resuscitation Council UK (2005). ''Resuscitation Guidelines 2005'' London: Resuscitation Council UK.</ref>
* '''Early [[Cardiopulmonary resuscitation|CPR]]''' - This buys time by keeping vital organs perfused with oxygen whilst waiting for equipment and trained personnel to reverse the arrest. In particular, by keeping the brain supplied with oxygenated blood, chances of neurological damage are decreased.
* '''Early defibrillation''' - This is the only effective for [[Ventricular fibrillation]], and also has benefit in [[Ventricular tachycardia]]<ref name = "RCUK2005"/>. If defibrillation is delayed, then the rhythm is likely to degenerate into [[Asystole]], for which outcomes are markedly worse.
* '''Early post-resuscitation care''' - Treatment and rehabillitation in a hospital by specialist staff helps to prevent further complications, attempts to fully reverse the underlying cause, and promotes quality of life.


If one or more links in the chain are missing or delayed, then the chances of survival drop significantly. In particular, bystander CPR is an important indicator of survival: if it has not been carried out, then resuscitation is associated with very poor results. Paramedics in some jurisdictions are authorised to abandon resuscitation altogether if the early stages of the chain have not been carried out in a timely fashion prior to their arrival.
=== Medical Therapy ===


Because of this, considerable effort has been put into educating the public on the need for CPR. In addition, there is increasing use of public access defibrillation. This involves placing [[Automated external defibrillator]]s in public places, and training key staff in these areas how to use them. This allows defibrillation to take place prior to the arrival of emergency services, and has been shown to lead to increased chances of survival. In addition, it has been shown that those who suffer arrests in remote locations have worse outcomes following cardiac arrest <ref name="pmid15333549">{{cite journal |author=Lyon RM, Cobbe SM, Bradley JM, Grubb NR |title=Surviving out of hospital cardiac arrest at home: a postcode lottery? |journal=Emerg Med J |volume=21 |issue=5 |pages=619–24 |year=2004 |month=September |pmid=15333549 |pmc=1726412 |doi=10.1136/emj.2003.010363 |url=}}</ref>: these areas often have [[First responder]] schemes, whereby members of the community receive training in resuscitation and are given a defibrillator, and called by the emergency medical services in the case of a collapse in their local area.
* The mainstay of [[therapy]] for [[patients]] with [[cardiac arrest]]  is starting [[cardiopulmonary resuscitation]] ([[CPR]]) with minimizing interruption in [[chest compression]].<ref name="PrioriBlomström-Lundqvist2015">{{cite journal|last1=Priori|first1=Silvia G.|last2=Blomström-Lundqvist|first2=Carina|last3=Mazzanti|first3=Andrea|last4=Blom|first4=Nico|last5=Borggrefe|first5=Martin|last6=Camm|first6=John|last7=Elliott|first7=Perry Mark|last8=Fitzsimons|first8=Donna|last9=Hatala|first9=Robert|last10=Hindricks|first10=Gerhard|last11=Kirchhof|first11=Paulus|last12=Kjeldsen|first12=Keld|last13=Kuck|first13=Karl-Heinz|last14=Hernandez-Madrid|first14=Antonio|last15=Nikolaou|first15=Nikolaos|last16=Norekvål|first16=Tone M.|last17=Spaulding|first17=Christian|last18=Van Veldhuisen|first18=Dirk J.|title=2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death|journal=European Heart Journal|volume=36|issue=41|year=2015|pages=2793–2867|issn=0195-668X|doi=10.1093/eurheartj/ehv316}}</ref><ref name="Al-KhatibStevenson2018">{{cite journal|last1=Al-Khatib|first1=Sana M.|last2=Stevenson|first2=William G.|last3=Ackerman|first3=Michael J.|last4=Bryant|first4=William J.|last5=Callans|first5=David J.|last6=Curtis|first6=Anne B.|last7=Deal|first7=Barbara J.|last8=Dickfeld|first8=Timm|last9=Field|first9=Michael E.|last10=Fonarow|first10=Gregg C.|last11=Gillis|first11=Anne M.|last12=Granger|first12=Christopher B.|last13=Hammill|first13=Stephen C.|last14=Hlatky|first14=Mark A.|last15=Joglar|first15=José A.|last16=Kay|first16=G. Neal|last17=Matlock|first17=Daniel D.|last18=Myerburg|first18=Robert J.|last19=Page|first19=Richard L.|title=2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death|journal=Circulation|volume=138|issue=13|year=2018|issn=0009-7322|doi=10.1161/CIR.0000000000000549}}</ref>
*[[CPR]] and use of [[automated external defibrillators]] ([[AED]]) increase the chances of [[survival]] with improved [[neurological] and [[functional]] outcomes <ref name="pmid32087741">{{cite journal| author=Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z | display-authors=etal| title=The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. | journal=Crit Care | year= 2020 | volume= 24 | issue= 1 | pages= 61 | pmid=32087741 | doi=10.1186/s13054-020-2773-2 | pmc=7036236 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32087741  }} </ref> <ref name="pmid15306665">{{cite journal| author=Hallstrom AP, Ornato JP, Weisfeldt M, Travers A, Christenson J, McBurnie MA | display-authors=etal| title=Public-access defibrillation and survival after out-of-hospital cardiac arrest. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 7 | pages= 637-46 | pmid=15306665 | doi=10.1056/NEJMoa040566 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15306665  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15656543 Review in: ACP J Club. 2005 Jan-Feb;142(1):2]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15830423 Review in: Evid Based Nurs. 2005 Apr;8(2):50] </ref> <ref name="pmid31862250">{{cite journal| author=Nakashima T, Noguchi T, Tahara Y, Nishimura K, Yasuda S, Onozuka D | display-authors=etal| title=Public-access defibrillation and neurological outcomes in patients with out-of-hospital cardiac arrest in Japan: a population-based cohort study. | journal=Lancet | year= 2019 | volume= 394 | issue= 10216 | pages= 2255-2262 | pmid=31862250 | doi=10.1016/S0140-6736(19)32488-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31862250  }} </ref> <ref name="pmid29483086">{{cite journal| author=Pollack RA, Brown SP, Rea T, Aufderheide T, Barbic D, Buick JE | display-authors=etal| title=Impact of Bystander Automated External Defibrillator Use on Survival and Functional Outcomes in Shockable Observed Public Cardiac Arrests. | journal=Circulation | year= 2018 | volume= 137 | issue= 20 | pages= 2104-2113 | pmid=29483086 | doi=10.1161/CIRCULATIONAHA.117.030700 | pmc=5953778 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29483086  }} </ref> <ref name="pmid28467879">{{cite journal| author=Kragholm K, Wissenberg M, Mortensen RN, Hansen SM, Malta Hansen C, Thorsteinsson K | display-authors=etal| title=Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 18 | pages= 1737-1747 | pmid=28467879 | doi=10.1056/NEJMoa1601891 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28467879  }} </ref> <ref name="pmid27783922">{{cite journal| author=Kitamura T, Kiyohara K, Sakai T, Matsuyama T, Hatakeyama T, Shimamoto T | display-authors=etal| title=Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 17 | pages= 1649-1659 | pmid=27783922 | doi=10.1056/NEJMsa1600011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27783922  }} </ref> <ref name="pmid26061835">{{cite journal| author=Hasselqvist-Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P | display-authors=etal| title=Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 24 | pages= 2307-15 | pmid=26061835 | doi=10.1056/NEJMoa1405796 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26061835  }} </ref>.
* [[Acute termination]] of [[acute coronary syndrome]] ([[ACS]]) can be achieved through [[defibrillation]] or [[electrical cardioversion]] <ref name="pmid31353412">{{cite journal| author=Kalarus Z, Svendsen JH, Capodanno D, Dan GA, De Maria E, Gorenek B | display-authors=etal| title=Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization: an European Heart Rhythm Association (EHRA) consensus document, endorsed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Acute Cardiovascular Care Association (ACCA). | journal=Europace | year= 2019 | volume= 21 | issue= 10 | pages= 1603-1604 | pmid=31353412 | doi=10.1093/europace/euz163 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31353412  }} </ref> <ref name="pmid2887775">{{cite journal| author=Rankin AC, Rae AP, Cobbe SM| title=Misuse of intravenous verapamil in patients with ventricular tachycardia. | journal=Lancet | year= 1987 | volume= 2 | issue= 8557 | pages= 472-4 | pmid=2887775 | doi=10.1016/s0140-6736(87)91790-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2887775  }} </ref>.


===Cardiac Arrest: Hospital treatment===
==2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death <ref name="pmid36017572">{{cite journal| author=Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA | display-authors=etal| title=2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. | journal=Eur Heart J | year= 2022 | volume= 43 | issue= 40 | pages= 3997-4126 | pmid=36017572 | doi=10.1093/eurheartj/ehac262 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36017572 }} </ref>==
Treatment within a hospital usually follows [[advanced life support]] protocols. Depending on the [[diagnosis]], various treatments are offered, ranging from [[defibrillation]] (for [[ventricular fibrillation]] or [[ventricular tachycardia]]) to [[surgery]] (for cardiac arrest which can be reversed by surgery - see causes of arrest, above) to [[medication]] (for [[asystole]] and [[pulseless electrical activity|PEA]]). All will include[[CPR]].  Consult the AHA guidelines for the most up to date algorithms.


===Peri-arrest period===
 
The period (either before or after) surrounding a cardiac arrest is known as the '''peri-arrest period'''. During this period the patient is in a highly unstable condition and must be constantly monitored in order to halt the progression or repeat of a full cardiac arrest. The [[preventative treatment]] used during the peri-arrest period depends on the causes of the impending arrest and the likelihood such an event occurring.
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for public basic life support and access to automated external defibrillators'''''
|-
| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
|-
| bgcolor="LightGreen"|
* It is recommended that public access [[defibrillation]] be available at sites where [[cardiac arrest]] is more likely to occur.
|-
| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
|-
| bgcolor="LightGreen"|
*Prompt [[CPR]] by bystanders is recommended at out-of-hospital cardiac arrest.
|-
| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
|-
| bgcolor="LightGreen"|
* It is recommended to promote [[community]] training in [[basic life support]] to increase bystander [[CPR]] rate and [[AED]] use.
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
|-
| bgcolor="LemonChiffon"|
* Mobile phone-based alerting of [[basic life support]]-trained bystander volunteers to assist nearby out-of-hospital cardiac arrest victims should be considered.
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for treatment of sudden cardiac death in patients with coronary anomalies'''
|-
| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LightGreen"|
* [[Surgery]] is recommended in [[patients]] with [[anomalous aortic origin]] of a [[coronary artery]] with [[cardiac arrest]], [[syncope]] suspected to be due to [[ventricular arrhythmias]], or [[angina]] when other [[causes]] have been [[excluded.
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LemonChiffon"|
* [[Surgery]] should be considered in [[asymptomatic]] [[patients]] with [[anomalous aortic organ]] of a [[coronary artery]] and evidence of [[myocardial ischemia]] or [[abnormal aortic origin]] f the [[left]] [[anatomy]].
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for the management of patients with idiopathic premature ventricular complexes/ ventricular tachycardia'''
|-
| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
|-
| bgcolor="LightGreen"|
* [[Catheter ablation]] as first-line [[treatment]] is recommended for [[symptomatic]] [[idiopathic]] [[ventricular tachycardia]] ([[VT]])/ [[premature ventricular complex]] ([[PVC]]s) from the [[right ventricular outflow tract]] ([[RVOT]]) or the [[left]] [[fascicles]].
|-
| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LightGreen"|
* [[Beta blockers]] or [[non-dihydropiridine calcium channel blockers]] ([[CCB]]s) are indicated in [[symptomatic]] [[patients]] with [[idiopathic]] [[VT]]/ [[PVC]]s from an origin other than the [[RVOT]] or the left [[fascicles]].
|-
| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
|-
| bgcolor="LightGreen"|
* [[Beta blockers]], [[non-dihydropiridine]] [[CCB]]s, or [[flecainide]] should be considered when [[catheter ablation]] is not available, desired, or is particularly risky in [[symptomatic]] [[patients]] with [[idiopathic]] [[VT]]/ [[PVC]]s from the [[RVOT]] or the [[left]] [[fascicle]].
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LemonChiffon"|
* [[Catheter ablation]] or [[flecainide]] should be considered in [[symptomatic]] [[patients]] with [[idiopathic]] [[VT]]/ [[PVC]]s from an origin other than the [[RVOT]] or the [[left]] [[fascicles]].
|-
| colspan="1" style="text-align:center; background:Orange"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIb]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
|-
| bgcolor="Orange"|
* [[Catheter ablation]] may be considered for [[idiopathic]]] [[VT]]/[[PVC]]s in [[asymptomatic]] [[patients]] with repeatedly more than 20% of [[PVC]]s per day at follow-up.
|-
| colspan="1" style="text-align:center; background:Pink"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class III]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="Pink"|
* [[Catheter ablation]] od [[idiopathic]] [[VT]]/[[PVC]]s is not recommended in [[children]] <5 years of [[age]] or <10 kg [[weight]] except when previous [[medical]] [[therapy]] fails or when [[VT]] is not [[hemodynamically]] tolerated.
|-
| colspan="1" style="text-align:center; background:Pink"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class III]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="Pink"|
* [[Amiodarone]] as a first-line [[treatment]] is not recommended in [patients]] with [[idiopathic]] [[VT]]s/ [[PVC]]s.
|-
| colspan="1" style="text-align:center; background:Pink"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class III]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="Pink"|
* [[Verapamil]] is not recommended in [[children]] < 1 year of [[age]] with [[PVC]]/ [[VT]], particularly if they have [[signs]] of [[heart failure]] or concurrent use of other [[anti-arrhythmic drugs]].
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for the management of patients with premature ventricular complex-induced or premature ventricular complex-aggravated cardiomyopathy'''''
|-
| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LightGreen"|
* In [[patients]] with a [[cardiomyopathy]] suspected to be caused by frequent and predominately [[monomorphic]] [[PVC]]s, [[catheter ablation]] is recommended.
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LemonChiffon"|
* In [[patients]] with a [[cardiomyopathy]] suspected to be caused by frequent and predominately [[monomorphic]] [[PVC]]s, [[treatment]] with [[AAD]]s should be considered if [[catheter ablation]] is not desired, suspected to be high-risk, or unsuccessful.
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])'''''
|-
| bgcolor="LemonChiffon"|
* In [[patients]] with [[structural heart disease]] ([[SHD]]) in whom predominately monomorphic frequent [[PVC]]s are suspected to be contributing to the [[cardiomyopathy]], [[AAD]] ([[amiodarone]]) [[treatment]] or [[catheter ablation]] should be considered.
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="LemonChiffon"|
* In non-responders to [[cardiac resynchronization therapy]] ([[CRT]]) with frequent, predominately [[monomorphic PVCs]] limiting optimal [[biventricular pacing]] despite [[pharmacological therapy]], [[catheter ablation]] or [[AADs]] should be considered.
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for diagnosis of ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy'''''
|-
| colspan="1" style="text-align:center; background:Orange"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIb]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'''''
|-
| bgcolor="Orange"|
* [[Beta-blocker]] [[therapy]] may be considered in all [[patients]] with a [[definite diagnosis]] of [[ARVC]].
|}
 
==2017AHA/ACC/HRS Guideline for management of [[sudden cardiac arrest]] and [[ventricular arrhythmia]]==
<ref name="Al-KhatibStevenson2018">{{cite journal|last1=Al-Khatib|first1=Sana M.|last2=Stevenson|first2=William G.|last3=Ackerman|first3=Michael J.|last4=Bryant|first4=William J.|last5=Callans|first5=David J.|last6=Curtis|first6=Anne B.|last7=Deal|first7=Barbara J.|last8=Dickfeld|first8=Timm|last9=Field|first9=Michael E.|last10=Fonarow|first10=Gregg C.|last11=Gillis|first11=Anne M.|last12=Granger|first12=Christopher B.|last13=Hammill|first13=Stephen C.|last14=Hlatky|first14=Mark A.|last15=Joglar|first15=José A.|last16=Kay|first16=G. Neal|last17=Matlock|first17=Daniel D.|last18=Myerburg|first18=Robert J.|last19=Page|first19=Richard L.|title=2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death|journal=Circulation|volume=138|issue=13|year=2018|issn=0009-7322|doi=10.1161/CIR.0000000000000549}}</ref>
 
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Recommendations for management of cardiac arrest'''
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''CPR ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence A]]):'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ [[CPR]] should be done according to basic and advanced cardiovascular life support algorithms <br>
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[Amiodarone]] ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence A]]) :'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ In the recurrence of [[ventricular arrhythmia]] after maximum energy shock delivery and unstable hemodynamic, [[amiodarone]] should de infused<br>
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[Direct current cardioversion]] : ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence A]])'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ In ventricular arrhythmia and unstable hemodynamic, direct current cardioversion should be delivered
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[Revascularization]]:([[ACC AHA guidelines classification scheme|Class I, Level of Evidence B]])'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ In patients with [[polymorphic VT]] and [[VF]] and evidence of acute [[STEMI]] in [[ECG]], coronary angiography and emergency revascularization is advised
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ Wide QRS tachycardia]]: ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence C]])'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ [[Wide QRS tachycardia]] should be considered as [[VT]] if the diagnosis is unclear
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | '''Intravenous [[procainamide]] ([[ACC AHA guidelines classification scheme|Class 2a, Level of Evidence A]]):'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ In hemodynamically stable [[VT]], intravenous [[procainamide]] is recommended
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Intravenous [[lidocaine]] : ([[ACC AHA guidelines classification scheme|Class 2a, Level of Evidence B]])'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ [[Lidocaine ]] is recommended in witness [[cardiac arrest]] due to polymorphic [[VT]], [[VF]] unresponsed to [[CPR]], [[defibrillation]] or [[ vasopressor therapy]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Intravenous [[betablocker]] : ([[ACC AHA guidelines classification scheme|Class 2a, Level of Evidence B]])'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ In polymorphic [[VT]] due to [[myocardial ischemia]], intravenous [[betablocker]] maybe helpful
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Intravenous [[Epinephrine]] : ([[ACC AHA guidelines classification scheme|Class 2b, Level of Evidence A]])'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ In [[cardiac arrest]] administration of 1 mg [[epinephrine]] every 3-5 minutes during [[CPR]] is recommended
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Intravenous [[amiodarone]] : ([[ACC AHA guidelines classification scheme|Class 2b, Level of Evidence B]])'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ In hemodynamic stable [[VT]], infusion of [[amiodarone]] or [[sotalole]] maybe considered
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |''' High dose of intravenous [[epinephrine]] : ([[ACC AHA guidelines classification scheme|Class III , Level of Evidence A]])'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ In [[cardiac arrest]], administration of high dose epinephrine>1 mg bolouses is not beneficial<br>
❑ In refractory [[VF]] not related to [[torsades de pointes]], administration of intravenous [[magnesium]] is not beneficial<br>
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Intravenous [[amiodarone]] : ([[ACC AHA guidelines classification scheme|Class III , Level of Evidence B]])'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑In acute [[myocardial infarction]], prophylactic administration of [[lidocaine]] or [[amiodarone]] for prevention of [[VT]] is harmful
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Intravenous [[verapamil]], [[diltiazem]] : ([[ACC AHA guidelines classification scheme|Class III , Level of Evidence C]])'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ In a wide [[QRS]] tachycardia with unknown origin, administration of [[verapamil]] and [[diltiazem]] is harmful
 
|}
 
 
{{familytree/start| | | | | | | | | | | | | |}}
{{familytree| | | | | | | | | | | A01 | | A01=Sustained monomorphic [[VT]]}}
{{familytree| | | | | | | | | | | |!| | | | | | | | }}
{{familytree| | | | | | | | | | | B01 | | | | | |B01=Hemodynamic stability}}
{{familytree| | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }}
{{familytree| | | | C01 | | | | | | | | | | | |C02|C01=Stable|C02=Unstable}}
{{familytree| | | | |!| | | | | | | | | | | | | |!| }}
{{familytree| | | | D01 | | | | | | | | | | | |D02|D01=12-Lead [[ECG]], [[history]], [[physical exam]]|D02=[[Dirrect current cardioversion]],[[ACLS]]}}
{{familytree| | | | |!| | | | | | | | | | | | | | | | | | | |}}
{{familytree| | | | E01 |,|-|E00|-|-|-|-|-|-|-|F02| | | | | | E01=Notifying disease causing [[VT]]|E00= Cardioversion(class1) |F02= [[VT]] termination}}
{{familytree| | | | |!| |!| |!| | | | | | | |,|-|^|-|.| | | | | }}
{{familytree| | | | F01 |+|-|F00| | | | | |S02| |  S03| | |F01=[[Structural heart disease]]|F00=Intravenous [[ procainamide]] (class2a)|S02=Yes, therapy of underlying [[heart]] disease|S03=NO, [[cardioversion]] (class1)}}
{{familytree| | | | |!| |!| |!| | | | | | | | | | | |!| | | | |}}
{{familytree| | | | L01 |`|-|L00| | | | | | | | | P01 | | | | | L00= Intravenous [[amiodarone]] or [[sotalole]] (class2b)|L01= NO, [[Ideopathic VT]]|P01=[[VT]] termination}}
{{familytree| | | | |!| | | | | | | | | | | | | | |!| | | | | |}}
{{familytree| | | | S01 | | | | | | | | | | | | | |!| | | | | |S01=[[Verapamil]] sensitive [[VT]]: [[Verapamil]]  outflow tract [[VT]]: [[betablocker]] (class2a) |}}
{{familytree| | |,|-|^|-|.| | | | | | | | | | |,|-|^|-|.| | | |}}
{{familytree| | |N01| |N02| | | | | | | | |  Q01| |  Q02| | | | | N01= Effective| N02=Non effective: [[cardioversion]]|Q01= Yes,therapy of underlying heart disease|Q02=NO, [[Sedation]] ,[[anesthesia]], reassessing [[antiarrhythmic]] therapy, repeating [[cardioversion]]}}
{{familytree| | |!| | | | | | | | | | | | | | | | | | |!| | | |}}
{{familytree| | |M01| | | | | | | | | | | | | | | | |  R01| | | |M01= Therapy to prevent recurrence of [[VT]] |R01= No [[VT]] termination}}
{{familytree|,|-|^|-|.| | | | | | | | | | | | | | | | |!| | | |}}
{{familytree|!| | | |!| | | | | | | | | | | | | | | | |R02| | |R02= [[Catheter ablation]] (class1) |}}
{{familytree|G01| |G02| | | | | | | | | | | | | | | | | | | | | G01=Catheter ablation (class1)| G02= [[ Verapamil]] , [[betablocker]] (class2a)}}
{{familytree| | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree/end}}
 
 
 
=== Intervention ===
[[Catheter ablation]] can only be performed for patients with sustained monomorphic [[ventricular tachycardia]] based on these characteristics:
*Incessant [[VT]] or electrical storm due to [[myocardial]] scar tissue
* Sustained [[VT]] and recurrent [[ICD]] shock in [[ischemic heart disease]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Public health]]
[[Category:Electrophysiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Needs overview]]
{{WH}}
{{WH}}
{{WS}}
{{WS}}

Latest revision as of 16:59, 22 July 2023

Sudden cardiac death Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Sara Zand, M.D.[2] Edzel Lorraine Co, DMD, MD[3]

Overview

The mainstay of therapy for patients with cardiac arrest is starting cardiopulmonary resuscitation (CPR) with minimizing interruption in chest compression. The rhythm should be reassessed. If the rhythm is ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), the shock should be delivered immediately. If the rhythm is asystole or pulseless electrical activity (PEA), CPR should be resumed. Advanced life support (ALS) should be kept with minimizing interruption in chest compression including: advanced airway, continuous chest compressions, capnography, intravenous (IV) intraosseous/ (IO) access, vasopressors, and antiarrhythmic therapy. This can address reversible causes such as hypoxia, hypovolemia,hypothermia, hyperkalemia, hypokalemia,acidosis, tension pneumothorax, tamponade, toxins (benzodiazepines, alcohol, opiates, tricyclics, barbiturates, betablockers, calcium channel blockers), thrombosis ST elevation myocardial infarction (STEMI, and massive pulmonary thromboembolism). The following should be considered immediately in post cardiac arrest patients: 12–lead electrocardiogram (ECG) ,perfusion/reperfusion in patients with acute myocardial infarction,(AMI), oxygenation and ventilation, temperature controlling, and treatment of reversible causes. Management of patients in post-cardiac arrest status include treatment of the underlying disorder, hemodynamic stability, respiratory support, and control of neurologic complications.


Urgent Treatment

Medical Therapy

2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death [12]

Recommendations for public basic life support and access to automated external defibrillators
Class I (Level of Evidence: B)
Class I (Level of Evidence: B)
  • Prompt CPR by bystanders is recommended at out-of-hospital cardiac arrest.
Class I (Level of Evidence: B)
Class IIa (Level of Evidence: B)
  • Mobile phone-based alerting of basic life support-trained bystander volunteers to assist nearby out-of-hospital cardiac arrest victims should be considered.
Recommendations for treatment of sudden cardiac death in patients with coronary anomalies
Class I (Level of Evidence: C)
Class IIa (Level of Evidence: C)
Recommendations for the management of patients with idiopathic premature ventricular complexes/ ventricular tachycardia
Class I (Level of Evidence: B)
Class I (Level of Evidence: C)
Class IIa (Level of Evidence: B)
Class IIa (Level of Evidence: C)
Class IIb (Level of Evidence: B)
Class III (Level of Evidence: C)
Class III (Level of Evidence: C)
Class III (Level of Evidence: C)
Recommendations for the management of patients with premature ventricular complex-induced or premature ventricular complex-aggravated cardiomyopathy
Class I (Level of Evidence: C)
Class IIa (Level of Evidence: C)
Class IIa (Level of Evidence: B)
Class IIa (Level of Evidence: C)
Recommendations for diagnosis of ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy
Class IIb (Level of Evidence: C)

2017AHA/ACC/HRS Guideline for management of sudden cardiac arrest and ventricular arrhythmia

[2]

Recommendations for management of cardiac arrest
CPR (Class I, Level of Evidence A):

❑ CPR should be done according to basic and advanced cardiovascular life support algorithms

Amiodarone (Class I, Level of Evidence A) :

❑ In the recurrence of ventricular arrhythmia after maximum energy shock delivery and unstable hemodynamic, amiodarone should de infused

Direct current cardioversion : (Class I, Level of Evidence A)

❑ In ventricular arrhythmia and unstable hemodynamic, direct current cardioversion should be delivered

Revascularization:(Class I, Level of Evidence B)

❑ In patients with polymorphic VT and VF and evidence of acute STEMI in ECG, coronary angiography and emergency revascularization is advised

Wide QRS tachycardia: (Class I, Level of Evidence C)

❑ Wide QRS tachycardia should be considered as VT if the diagnosis is unclear

Intravenous procainamide (Class 2a, Level of Evidence A):

❑ In hemodynamically stable VT, intravenous procainamide is recommended

Intravenous lidocaine : (Class 2a, Level of Evidence B)

❑ Lidocaine is recommended in witness cardiac arrest due to polymorphic VT, VF unresponsed to CPR, defibrillation or vasopressor therapy

Intravenous betablocker : (Class 2a, Level of Evidence B)

❑ In polymorphic VT due to myocardial ischemia, intravenous betablocker maybe helpful

Intravenous Epinephrine : (Class 2b, Level of Evidence A)

❑ In cardiac arrest administration of 1 mg epinephrine every 3-5 minutes during CPR is recommended

Intravenous amiodarone : (Class 2b, Level of Evidence B)

❑ In hemodynamic stable VT, infusion of amiodarone or sotalole maybe considered

High dose of intravenous epinephrine : (Class III , Level of Evidence A)

❑ In cardiac arrest, administration of high dose epinephrine>1 mg bolouses is not beneficial
❑ In refractory VF not related to torsades de pointes, administration of intravenous magnesium is not beneficial

Intravenous amiodarone : (Class III , Level of Evidence B)

❑In acute myocardial infarction, prophylactic administration of lidocaine or amiodarone for prevention of VT is harmful

Intravenous verapamil, diltiazem : (Class III , Level of Evidence C)

❑ In a wide QRS tachycardia with unknown origin, administration of verapamil and diltiazem is harmful


 
 
 
 
 
 
 
 
 
 
Sustained monomorphic VT
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hemodynamic stability
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stable
 
 
 
 
 
 
 
 
 
 
 
Unstable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
12-Lead ECG, history, physical exam
 
 
 
 
 
 
 
 
 
 
 
Dirrect current cardioversion,ACLS
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Notifying disease causing VT
 
 
 
Cardioversion(class1)
 
 
 
 
 
 
 
VT termination
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Structural heart disease
 
 
 
Intravenous procainamide (class2a)
 
 
 
 
 
Yes, therapy of underlying heart disease
 
NO, cardioversion (class1)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NO, Ideopathic VT
 
 
 
Intravenous amiodarone or sotalole (class2b)
 
 
 
 
 
 
 
 
VT termination
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Verapamil sensitive VT: Verapamil outflow tract VT: betablocker (class2a)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Effective
 
Non effective: cardioversion
 
 
 
 
 
 
 
 
Yes,therapy of underlying heart disease
 
NO, Sedation ,anesthesia, reassessing antiarrhythmic therapy, repeating cardioversion
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Therapy to prevent recurrence of VT
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No VT termination
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Catheter ablation (class1)
 
 
Catheter ablation (class1)
 
Verapamil , betablocker (class2a)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Intervention

Catheter ablation can only be performed for patients with sustained monomorphic ventricular tachycardia based on these characteristics:

References

  1. ↑ Priori, Silvia G.; Blomström-Lundqvist, Carina; Mazzanti, Andrea; Blom, Nico; Borggrefe, Martin; Camm, John; Elliott, Perry Mark; Fitzsimons, Donna; Hatala, Robert; Hindricks, Gerhard; Kirchhof, Paulus; Kjeldsen, Keld; Kuck, Karl-Heinz; Hernandez-Madrid, Antonio; Nikolaou, Nikolaos; Norekvål, Tone M.; Spaulding, Christian; Van Veldhuisen, Dirk J. (2015). "2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death". European Heart Journal. 36 (41): 2793–2867. doi:10.1093/eurheartj/ehv316. ISSN 0195-668X.
  2. ↑ 2.0 2.1 Al-Khatib, Sana M.; Stevenson, William G.; Ackerman, Michael J.; Bryant, William J.; Callans, David J.; Curtis, Anne B.; Deal, Barbara J.; Dickfeld, Timm; Field, Michael E.; Fonarow, Gregg C.; Gillis, Anne M.; Granger, Christopher B.; Hammill, Stephen C.; Hlatky, Mark A.; Joglar, José A.; Kay, G. Neal; Matlock, Daniel D.; Myerburg, Robert J.; Page, Richard L. (2018). "2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death". Circulation. 138 (13). doi:10.1161/CIR.0000000000000549. ISSN 0009-7322.
  3. ↑ Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z; et al. (2020). "The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis". Crit Care. 24 (1): 61. doi:10.1186/s13054-020-2773-2. PMC 7036236 Check |pmc= value (help). PMID 32087741 Check |pmid= value (help).
  4. ↑ Hallstrom AP, Ornato JP, Weisfeldt M, Travers A, Christenson J, McBurnie MA; et al. (2004). "Public-access defibrillation and survival after out-of-hospital cardiac arrest". N Engl J Med. 351 (7): 637–46. doi:10.1056/NEJMoa040566. PMID 15306665. Review in: ACP J Club. 2005 Jan-Feb;142(1):2 Review in: Evid Based Nurs. 2005 Apr;8(2):50
  5. ↑ Nakashima T, Noguchi T, Tahara Y, Nishimura K, Yasuda S, Onozuka D; et al. (2019). "Public-access defibrillation and neurological outcomes in patients with out-of-hospital cardiac arrest in Japan: a population-based cohort study". Lancet. 394 (10216): 2255–2262. doi:10.1016/S0140-6736(19)32488-2. PMID 31862250.
  6. ↑ Pollack RA, Brown SP, Rea T, Aufderheide T, Barbic D, Buick JE; et al. (2018). "Impact of Bystander Automated External Defibrillator Use on Survival and Functional Outcomes in Shockable Observed Public Cardiac Arrests". Circulation. 137 (20): 2104–2113. doi:10.1161/CIRCULATIONAHA.117.030700. PMC 5953778. PMID 29483086.
  7. ↑ Kragholm K, Wissenberg M, Mortensen RN, Hansen SM, Malta Hansen C, Thorsteinsson K; et al. (2017). "Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest". N Engl J Med. 376 (18): 1737–1747. doi:10.1056/NEJMoa1601891. PMID 28467879.
  8. ↑ Kitamura T, Kiyohara K, Sakai T, Matsuyama T, Hatakeyama T, Shimamoto T; et al. (2016). "Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan". N Engl J Med. 375 (17): 1649–1659. doi:10.1056/NEJMsa1600011. PMID 27783922.
  9. ↑ Hasselqvist-Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P; et al. (2015). "Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest". N Engl J Med. 372 (24): 2307–15. doi:10.1056/NEJMoa1405796. PMID 26061835.
  10. ↑ Kalarus Z, Svendsen JH, Capodanno D, Dan GA, De Maria E, Gorenek B; et al. (2019). "Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization: an European Heart Rhythm Association (EHRA) consensus document, endorsed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Acute Cardiovascular Care Association (ACCA)". Europace. 21 (10): 1603–1604. doi:10.1093/europace/euz163. PMID 31353412.
  11. ↑ Rankin AC, Rae AP, Cobbe SM (1987). "Misuse of intravenous verapamil in patients with ventricular tachycardia". Lancet. 2 (8557): 472–4. doi:10.1016/s0140-6736(87)91790-9. PMID 2887775.
  12. ↑ Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA; et al. (2022). "2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death". Eur Heart J. 43 (40): 3997–4126. doi:10.1093/eurheartj/ehac262. PMID 36017572 Check |pmid= value (help).


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