Sudden cardiac death urgent treatment

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Treatment of 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%
• Early 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. 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.

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 defibrillators 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 : 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.

Treatment of in Hospital Cardiac Arrest

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 PEA). All will includeCPR. Consult the AHA guidelines for the most up to date algorithms.

Management During the 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.

References

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