Optimizing Survival Outcomes For Adult Patients With Nontraumatic Cardiac Arrest
Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm. Management of cardiac arrest in circumstances such as pregnancy, pulmonary embolism, opioid overdose and other toxicologic causes, hypothermia, and coronary ischemia are also reviewed.
Key words: cardiac arrest, cardiopulmonary resuscitation, CPR, basic life support, resuscitation, ventricular fibrillation, ventricular tachycardia, pulseless electrical activity, asystole, automated external defibrillator, chest compression, vasopressor, antiarrhythmic, postarrest care, targeted temperature management, extracorporeal CPR, shockable rhythm, nonshockable rhythm, hypoxia
- Acute coronary syndromes (ACS) account for 35% to 40% of cardiac causes of arrest. Electrocardiogram (ECG) is not reliable for identifying ST-elevation myocardial infarction (STEMI) in the postarrest period.
- Cardiac catheterization should be considered for all successfully resuscitated patients with a suspected cardiac etiology of arrest.
- Among non-cardiac causes of arrest, hypoxia is the most common, accounting for approximately 20% of cases; other frequent causes include hypovolemia, pulmonary embolism, pericardial tamponade, and sepsis.
- Immediate defibrillation should be prioritized over a period of CPR unless a defibrillator is not immediately available.
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- » Authors & Peer Reviewers
- » Case Presentations & Case Conclusions
- » Introduction
- » Critical Appraisal Of The Literature
- » Etiology And Pathophysiology
- » Differential Diagnosis
- » Prehospital Care
- » Emergency Department Evaluation
- » Diagnostic Studies
- » Treatment
- » Special Circumstances
- » Controversies And Cutting Edge
- » Disposition
- » Summary
- » Risk Management Pitfalls For Cardiac Arrest
- » Time- And Cost-Effective Strategies
- » Clinical Pathway For Management Of Cardiac Arrest In The Emergency Department
- » Tables And Figures
- » References
- » Sudden Cardiac Arrest: Acute Management And Long-Term Prevention - Hospital Medicine Practice - June 2014
- » Practical Aspects Of Postcardiac Arrest Therapeutic Hypothermia (FREE) - EM Critical Care - June 2013
- » Postarrest Cardiocerebral Resuscitation: An Evidence-Based Review (FREE) - EM Critical Care - October 2012
- » Current Evidence In Therapeutic Hypothermia For Postcardiac Arrest Care (FREE) - Emergency Medicine Practice - October 2009