CARDIOPULMONARY

ARREST

Background

Every year in US, more than 250.000 person died suddenly

because of a cardiovascular disease

Evaluation and effective treatment for patients at risk of cardiac

arrest requires an understanding of Pathomecanism of cardiac
arrest so that the strategy in primary prevention as well as the
techniques and modalities of treatment in secondary prevention
can be prepared to obtain better results.

Cardiac arrest cases may rarely / not always available every day
as a healthcare practitioner. But every member of a health
practitioner must master and competent in performing basic life
support for cardiac arrest which is a Life-Threatening case.

Defenition
Cardiopulmonarry arrest is an Abrupt cessation of
cardiac mechanical function, which may be reversible
with prompt intervention but will lead to death in its
absence
Rare spontaneous reversions; the likelihood of
successful intervention is related to the mechanism of
arrest, clinical setting, and prompt return of circulation

Epidemiology

In the US and Canada,approximately 350 000 people/year

(approximately half of them in-hospital) suffer a cardiac
arrest and receive attempted resuscitation.

In the US and Canada, Cardiac arrest case is about 50 to

55/100 000 persons/year and approximately 25% of these
present with pulseless ventricular arrhythmias.

The vast majority of cardiac arrest victims are adults, but

thousands of infants and children suffer either an in-hospital
or out-of-hospital cardiac arrest each year in the US and
Canada

Anatomy and Physiology

The heart is a muscular organ located in the chest cavity,

behind the sternum, in mediastinum, between the two
lungs, and in front of the spine. Heart is located in this area
such as the shape of an inverted triangle

Heart consist of 4 rooms that is Right and Left Atrium, also

right and left ventricle.

BLOOD FLOW
Blood flow start from the Left
Ventricle and go to the all of the
body and then there is an oxygen
and carbondioxyde change happen
at there. After that the blood going
back to the heart by venous return
and enter the right atrium by
superior and inferior vena cava and
then to the right ventricle pass the
tricuspid valve. The blood then being
pumped to the lung by the
pulmonary artery, the gas exchange,
and the blood go back to the left
atrium. Go to left ventricle pass the
mitral valve and is pumped to all of
the body again.

ELECTRICAL
CONDUCTION

The heart's electrical conduction

starts from the first pacemaker that is
located below the vena cava That is
the SA node. After that the electrical
impulse pass the internodes and
delivered to the AV node. Here the
electrical impulse being slowdown to
depolarize the entire muscle atrium
starting from the right atrium to the
left atrium. After that the electrical
impulse is delivered to the HIS fibers
to depolarize the ventricles septum
then to the Purkinje to depolarize the
entire wall of the left and right
ventricle.

Etiology
The loss of function of the heart in cardiac arrest can be
caused by conditions such as :
1.

Coronary Artery Abnormalities

2.

Ventricular Hypertrophy and Hypertrophic

Cardiomyopathy

3.

Nonischemic Cardiomyopathy

4.

Acute Heart Failure

5.

Electrophysiology abnormality (Short and Long QT

Syndrome, Brugada Syndrome)

6.

Other Cardiac disease (Valvular Heart Disease, And

Congenital Heart disease)

Coronary Artery
Abnormalities
Is the most cause (80%) of the cardiac arrest and
can be happened because of :

Atherosclerotic Coronary Artery Disease

Myocardial Infarc or ischaemic can make a

ventricle Fibrilation.

Nonatherosclerotic Coronary Artery Abnormalities

Such as Embolism to the Coronary Arteries,

Coronary Arteritis, and Coronary artery spasm.

Nonischemic Cardiomyopathy
Is 10% of the most cause of the cardiac arrest. This
disease can cause an arrhythmia of the heart like
monomorphic or polymorphic tachycardia ventricle
which can make an cardiac arrest and sudden death

Pathophysiology
All of the etiology will make an abnormal electrical
conduction, that is :
1.

Ventricle Fibrillation

2.

Pulseless ventricular tachycardia

3.

Pulseless electrical activity (PEA)

4.

Asystole

Ventricular Fibrillation

Ventricular fibrillation probably begins in a localised area from

which waves of activation will spread in all directions.

The myocardial will contract in an uncoordinated. This is caused

by the continuous re-entry of waves of activation.

The main cause of this arrhythmia is Myocardial ischaemia or

infarction. But can be caused also by Cardiomyopathy, Acidosis,
Electrolyte disturbance.

The ECG will shown a rapid irregular deflections of varying

amplitude and morphology and no discernible QRS complexes

Fine Type VF

Coarse Type VF

Pulseless Ventricular Tachycardia

Ventricular tachycardias are the result of increased myocardial

automaticity or are secondary to a re-entry phenomenon. They
can result from direct myocardial damage, cardiomyopathy, or
be caused by class 1 antiarrhythmics drug.

In ventricular tachycardias ECG there will be a broad complex,

regular tachycardia with a rate of at least 120 beats/min. The
diagnosis is confirmed if there is direct or indirect evidence of
atrioventricular dissociation, such as capture beat, fusion beat,
or independent P wave activity.

Atrioventricular dissociation

Pulseless electrical activity

In pulseless electrical activity the heart continues to

work electrically but fails to provide a cardiac output
sufficient to produce a palpable pulse.

The other cause of PEA are Hypovolaemia, Cardiac

tamponade.

The appearance of the electrocardiogram varies, but

several common patterns exist.

Asystole

Asystole implies the absence of any cardiac electrical activity.

It results from a failure of impulse formation in the pacemaker
tissue or from a failure of propagation to the ventricles.

In asystole the electrocardiogram shows an almost flat line.

Slight undulations are present because of baseline drift

Asystole with undulation

Asystole Flat line type

Treatment
The Principal of cardiac arrest treatment is doing a CHAIN OF SURVIVAL
which is consist by :
1.

Early recognition and activation actually an cardiac arrest patient is

unresponsive, no breathing or no normal breating (only gasp), and no
pulse.

2.

Early CPR

3.

Early defibrillation if there an AED, better we use it than doing CPR (in
Hospital cardiac arrest case) but just For VF and Pulseless VT, not for
asystole or PEA

4.

Effective advanced life support

5.

Integration of post-cardiac arrest care

The Highlight of the chain of

survival

AHA 2010
Guideline
for cardiac
arresst

CPR tehnique

Prognosis

The Result is based from how fast we recognize and how fast
we do CPR. This is because of 3 phase that happen in Cardiac
arrest (example VF)

1.

Phase 1 (electric phase) start from VF appear until 5

minutes after the cardiac arrest. This is the best phase we do
Defibrilation

2.

Phase 2 (Circulating and Haemodynamic phase) 5 15

minutes after cardiac arrest. CPR is the best method than the
defibrillation

3.

Phase 3 (metabolic Phase) more than 15 minutes the

effectiveness of CPR and defibrillation is decreased.