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Optimizing Survival Outcomes For Adult Patients With Nontraumatic Cardiac Arrest

October 2016

Abstract

SIPA_Best-Instructional-Reporting

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

Points:

  • 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.

Pearl:

  • Immediate defibrillation should be prioritized over a period of CPR unless a defibrillator is not immediately available.
 
 
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