, (also known as cardiopulmonary arrest or circulatory arrest
) is the cessation of normal circulation of the blood due to failure of the heart to contract effectively. Medical personnel can refer to an unexpected cardiac arrest as a sudden cardiac arrest or SCA.
A cardiac arrest is different from (but may be caused by) a heart attack, where blood flow to the muscle of the heart is impaired.
Arrested blood circulation prevents delivery of oxygen to the body. Lack of oxygen to the brain causes loss of consciousness, which then results in abnormal or absent breathing. Brain injury is likely if cardiac arrest goes untreated for more than five minutes
. For the best chance of survival and neurological recovery, immediate and decisive treatment is imperative.
Cardiac arrest is a medical emergency that, in certain situations, is potentially reversible if treated early. When unexpected cardiac arrest leads to death this is called sudden cardiac death (SCD). The treatment for cardiac arrest is cardiopulmonary resuscitation (CPR)
to provide circulatory support, followed by defibrillation if a shockable rhythm is present
. If a shockable rhythm is not present after CPR and other interventions, clinical death is inevitable.
Coronary heart disease is the leading cause of sudden cardiac arrest. Many other cardiac and non-cardiac conditions also increase ones risk.
- Approximately 60-70% of SCD is related to coronary heart disease. Among adults, ischemic heart disease is the predominant cause of arrest with 30% of people at autopsy showing signs of recent myocardial infarction;
- A number of other cardiac abnormalities can increase the risk of SCD including: cardiomyopathy, cardiac rhythm disturbances, hypertensive heart disease, congestive heart failure.
In a group of military recruits aged 18-35, cardiac anomalies accounted for 51% of cases of SCD, while in 35% of cases the cause remained unknown. Underlying pathology included: coronary artery abnormalities (61%), myocarditis (20%), and hypertrophic cardiomyopathy (13%). Congestive heart failure increases the risk of SCD by 5 fold.
Many additional conduction abnormalities exist that place one at higher risk for cardiac arrest. For instance, long QT syndrome, a condition often mentioned in young people's deaths, occurs in 1/5000-1/7000 newborns and is estimated to be responsible 3000 deaths each year compared to the approximately 300000 cardiac arrests seen by emergency services . These conditions are a fraction of the overall deaths related to cardiac arrest, but represent conditions which may be detected prior to arrest, which maybe treatable.;
- SCDs is unrelated to heart problems in 35% of cases. The most common non-cardiac causes: trauma, non-trauma related bleeding (such as gastrointestinal bleeding, aortic rupture, and intracranial hemorrhage), overdose, drowning and pulmonary embolism.
Diagnosis of a Cardiac Arrest
Cardiac arrest is synonymous with clinical death:
- A cardiac arrest is usually diagnosed clinically by the absence of a pulse. In many cases lack of carotid pulse is the gold standard for diagnosing cardiac arrest, but lack of a pulse (particularly in the peripheral pulses) may be a result of other conditions (e.g. shock), or simply an error on the part of the rescuer. Studies have shown that rescuers often make a mistake when checking the carotid pulse in an emergency, whether they are healthcare professionals or lay persons;
- Owing to the inaccuracy in this method of diagnosis, some bodies such as the European Resuscitation Council (ERC) have de-emphasised its importance. The Resuscitation Council (UK), in line with the ERC's recommendations and those of the American Heart Association, have suggested that the technique should be used only by healthcare professionals with specific training and expertise, and even then that it should be viewed in conjunction with other indicators such as agonal respiration;
- Various other methods for detecting circulation have been proposed. Guidelines following the 2000 International Liaison Committee on Resuscitation (ILCOR) recommendations were for rescuers to look for "signs of circulation", but not specifically the pulse. These signs included coughing, gasping, colour, twitching and movement. However, in face of evidence that these guidelines were ineffective, the current recommendation of ILCOR is that cardiac arrest should be diagnosed in all casualties who are unconscious and not breathing normally.
With positive outcomes following cardiac arrest unlikely, an effort has been spent in finding effective strategies to prevent cardiac arrest. With the prime causes of cardiac arrest being ischemic heart disease, efforts to promote a healthy diet, exercise, and smoking cessation are important. For people at risk of heart disease, measures such as blood pressure control, cholesterol lowering, and other medico-therapeutic interventions are used.
Wikipedia page: http://en.wikipedia.org/wiki/Cardiac_arrest
This page was last modified on 16 September 2011 at 16:17
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