Citizendia
Your Ad Here

For other uses, see Cardiac arrest (disambiguation).
Cardiac arrest
Classification and external resources
ICD-10 I46.
ICD-9 427.5
MeSH D006323

A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during systole. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings I00-I99 - Diseases of the Circulatory system (I00-I02 Acute rheumatic fever ( Rheumatic fever without mention of Heart The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells such as nutrients and oxygen—and transports Waste products The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic Systole (ˈsɪstɒli rhymes with "fiscally" is the contraction of Heart chambers driving blood out of the chambers [1]

A cardiac arrest is different from (but may be caused by) a heart attack or myocardial infarction, where blood flow to the still-beating heart is interrupted. Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply

"Arrested" blood circulation prevents delivery of oxygen to all parts of the body. Oxygen (from the Greek roots ὀξύς (oxys (acid literally "sharp" from the taste of acids and -γενής (-genēs (producer literally begetteris the Cerebral hypoxia, or lack of oxygen supply to the brain, causes victims to lose consciousness and to stop normal breathing, although agonal breathing may still occur. Chronic Hypoxia is a pathological condition in which the body as a whole ( generalized hypoxia) or region of the body ( tissue hypoxia) is deprived of adequate See also Unconscious mind. Unconsciousness, more appropriately referred to as loss of Consciousness or lack of consciousness is Respiratory arrest is the cessation of Breathing. It is a Medical emergency and it usually is related to or coincides with a Cardiac arrest. Agonal respiration is an abnormal pattern of breathing characterized by shallow slow (3-4 per minute irregular inspirations followed by irregular pauses Brain injury is likely if cardiac arrest is untreated for more than 5 minutes,[2] although new treatments such as induced hypothermia have begun to extend this time. [3][4] To improve survival and neurological recovery immediate response is paramount. [5]

Cardiac arrest is a medical emergency that, in certain groups of patients, is potentially reversible if treated early enough (See "Reversible causes" below). A medical emergency is an Injury or Illness that is acute and poses an immediate risk to a person's life or long term health A patient is any person who receives medical attention care or treatment. When unexpected cardiac arrest leads to death this is called sudden cardiac death (SCD). The term sudden cardiac death refers to Natural death from cardiac causes heralded by abrupt loss of Consciousness within one hour of the onset of acute symptoms [1] The primary first-aid treatment for cardiac arrest is cardiopulmonary resuscitation (commonly known as CPR) which provides circulatory support until availability of definitive medical treatment, which will vary dependant on the rhythm the heart is exhibiting, but often requires defibrillation. Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia.

Contents

Characteristics and diagnosis

Cardiac arrest is an abrupt cessation of pump function (evidenced by absence of a palpable pulse) of the heart that with prompt intervention could be reversed, but without it will lead to death. [1]

However, due to inadequate cerebral perfusion, the patient will be unconscious and will have stopped breathing. Breathing takes Oxygen in and Carbon dioxide out of the body Aerobic Organisms require oxygen to create energy via respiration, in The main diagnostic criterion to diagnose a cardiac arrest (as opposed to respiratory arrest, which shares many of the same features) is lack of circulation, however there are a number of ways of determining this. Respiratory arrest is the cessation of Breathing. It is a Medical emergency and it usually is related to or coincides with a Cardiac arrest.

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. In Medicine, a person's pulse is the throbbing of their arteries. In Medicine, a gold standard test or criterion standard test is a Diagnostic test or benchmark that is regarded as definitive 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[6][7] or lay persons. [8]

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,[9] 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. Agonal respiration is an abnormal pattern of breathing characterized by shallow slow (3-4 per minute irregular inspirations followed by irregular pauses [10]

Various other methods for detecting circulation have been proposed. Guidelines following the 2000 International Liaison Committee on Resusciation (ILCOR) recommendations were for rescuers to look for "signs of circulation", but not specifically the pulse [9]. These signs included coughing, gasping, colour, twitching and movement. [11] 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. [9]

Following initial diagnosis of cardiac arrest, healthcare professionals further categorise the diagnosis based on the ECG/EKG rhythm. There are 4 rhythms which result in a cardiac arrest. Ventricular fibrillation (VF/VFib) and pulseless ventricular tachycardia (VT) are both responsive to a defibrillator and so are colloquially referred to as "shockable" rhythms, whereas asystole and pulseless electrical activity (PEA) are non-shockable. Ventricular fibrillation ( V-fib or VF) is a condition in which there is uncoordinated contraction of the Cardiac muscle of the ventricles in the Ventricular tachycardia ( V-tach or VT) is a Tachycardia, or fast heart rhythm that originates in one of the ventricles of the Heart Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia. In medicine asystole is a state of no cardiac electrical activity hence no contractions of the Myocardium and no cardiac output or blood flow Pulseless Electrical Activity (also known by the older term Electromechanical Dissociation or Non-Perfusing Rhythm) refers to any heart rhythm observed on the The nature of the presenting hearth rhythm suggests different causes and treatment, and is used to guide the rescuer as to what treatment may be appropriate[10] (see Advanced life support and Advanced cardiac life support, as well as the causes of arrest below). Advanced Life Support (ALS- Implies that a EMT is capable of performing advanced life support skills as either an EMT-I (Intermediate or an EMT-P (Paramedic commonly referred Advanced cardiac life support or ( ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies as

Causes of cardiac arrest

Cardiac arrest is synonymous with Clinical death. Clinical death is the popular term for cessation of blood circulation and breathing All disease processes leading to death have a period of (potentially) reversible cardiac arrest: the causes of arrest are, therefore, numerous. However, many of these conditions, rather than causing an arrest themselves, promote one of the "Reversible causes" (see below), which then triggers the arrest (e. g. choking leads to hypoxia which in turn leads to an arrest). Choking is the mechanical obstruction of the flow of air from the environment into the lungs Chronic Hypoxia is a pathological condition in which the body as a whole ( generalized hypoxia) or region of the body ( tissue hypoxia) is deprived of adequate In some cases, the underlying mechanism cannot be overcome, leading to an unsuccessful resuscitation.

Among adults, ischemic heart disease is the predominant cause of arrest. Ischaemic or ischemic heart disease (IHD or myocardial ischaemia, is a Disease characterized by reduced blood supply to the heart muscle [12] At autopsy 30% of victims show signs of recent myocardial infarction. An autopsy, also known as a post-mortem examination, necropsy, or obduction, is a Medical procedure that consists of a thorough Examination Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply Other cardiac conditions potentially leading to arrest include structural abnormalities, arrhythmias and cardiomyopathies. Non-cardiac causes include infections, overdoses, trauma and cancer, in addition to many others.

Reversible causes

Cardiopulmonary resuscitation (CPR), including adjunctive measures such as defibrillation, intubation and drug administration, is the standard of care for initial treatment of cardiac arrest. However, most cardiac arrests occur for a reason, and unless that reason can be found and overcome, CPR is often ineffective, or if it does result in a return of spontaneous circulation, this is short lived. [10]. As highlighted above, a variety of disease processes can lead to a cardiac arrest, however they usually boil down to one or more of the "Hs and Ts". [13][14][15]

H's

T's

Checking respiration.
Checking respiration.
Checking carotid pulse.
Checking carotid pulse.
Insulfation mouth-to-mouth.
Insulfation mouth-to-mouth.

Treatment

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. Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply Ventricular fibrillation ( V-fib or VF) is a condition in which there is uncoordinated contraction of the Cardiac muscle of the ventricles in the The patient is therefore likely to be responsive to defibrillation, and this has become the focus of pre-hospital interventions. Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia. Several organisations promote the idea of a "chain of survival", of which defibrillation is a key step. The chain of survival refers to a series of actions that when put into motion reduce the mortality associated with Cardiac arrest. The links are:

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 [16]: 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. First responder is a term used to describe the first medically-trained responder to arrive on scene of an emergency accident natural or human-made disaster or similar event

Hospital treatment

Treatment within a hospital usually follows advanced life support protocols. Advanced Life Support (ALS- Implies that a EMT is capable of performing advanced life support skills as either an EMT-I (Intermediate or an EMT-P (Paramedic commonly referred In the US, non-traumatic adult resuscitation is described by ACLS(advanced cardiac life support), pediatric resuscitation is described by PALS (pediatric advanced life support), and neonatal resusciation is described by NALS (neonatal advanced life support. Pals is a Medieval town in Catalonia a few kilometres from the sea in the heart of the Bay of Emporda on the Costa Brava. Nals ( Italian: Nalles; German: Nals) is a Comune (municipality in the Province of Bolzano-Bozen in the ) 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). Diagnosis is the identification by Process of elimination, of the nature of anything Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia. Ventricular fibrillation ( V-fib or VF) is a condition in which there is uncoordinated contraction of the Cardiac muscle of the ventricles in the Ventricular tachycardia ( V-tach or VT) is a Tachycardia, or fast heart rhythm that originates in one of the ventricles of the Heart Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease In medicine asystole is a state of no cardiac electrical activity hence no contractions of the Myocardium and no cardiac output or blood flow Pulseless Electrical Activity (also known by the older term Electromechanical Dissociation or Non-Perfusing Rhythm) refers to any heart rhythm observed on the All will include CPR.

While specific details may vary, all hospitals have protocols as to how resuscitations should be performed in patients, visitors, or employees who have arrested unexpectedly in the hospital. These protocols are often initiated by a Code Blue, which usually denotes impending or acute onset of cardiac arrest or respiratory failure, although in practice, Code Blue is often called in less life-threatening situations that require immediate attention from a physician. Hospital Emergency Codes are used in hospitals worldwide to alert staff to various emergency situations Respiratory failure is a medical term for inadequate Gas exchange by the Respiratory system.

If not already done, a definitive airway will be establish by the placement of an endotracheal tube which is then attached to a mechanical ventilator. In Medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing when patients cannot do so on their own

Cardiac arrest is generally divided into two cases: presence of disorganized mechanical cardiac activity, or complete absence of mechanical cardiac activity.

Disorganized mechanical cardiac activity includes ventricular fibrillation and hemodynamically unstable or pulseless ventricular tachycardia. Ventricular fibrillation ( V-fib or VF) is a condition in which there is uncoordinated contraction of the Cardiac muscle of the ventricles in the This also includes torsade de pointes. Torsades de pointes, torsades or torsade de pointes is a French term that literally means "twisting of the points" These must all be treated primarily with defibrillation. Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia. Advanced cardiac life support algorithms also detail the stepwise administration of epinephrine, vasopressin, the antiarrhythmic agent amiodarone, as well as attempts to correct possible underlying causes. Arginine vasopressin ( AVP) also known as vasopressin, argipressin or antidiuretic hormone ( ADH) is a Hormone found in Antiarrhythmic agents are a group of Pharmaceuticals that are used to suppress fast rhythms of the Heart ( Cardiac arrhythmias) such as Atrial fibrillation Amiodarone is an Antiarrhythmic agent (medication used for irregular heart beat used for various types of tachyarrhythmias (fast forms of irregular heart beat both ventricular

Complete absence of mechanical cardiac activity includes asystole and pulseless electrical activity. In medicine asystole is a state of no cardiac electrical activity hence no contractions of the Myocardium and no cardiac output or blood flow Pulseless Electrical Activity (also known by the older term Electromechanical Dissociation or Non-Perfusing Rhythm) refers to any heart rhythm observed on the This is treated entirely with pharmacologic agents, specifically epinephrine and atropine. Atropine is a Tropane Alkaloid extracted from Deadly nightshade ( Atropa belladonna) Jimsonweed (Datura stramonium and other plants However, resuscitation is rarely successful without effective treatment of the underlying cause.

Patients that survive cardiac arrest are said to have return of spontaneous circulation (ROSC). When these patients remain comatose, survival and neurologic damage can be improved by cooling patients. Mild Therapeutic Hypothermia can be induced by a variety of methods. The most beneficial protocols are still being determined.

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. Generally speaking preventive medicine is the part of Medicine engaged with preventing Disease rather than curing it

Prognosis

The out-of-hospital cardiac arrest (OHCA) has a worse survival rate (2-8% at discharge and 8-22% on admission), than an in-hospital cardiac arrest (15% at discharge). The principal determining factor is the initially documented rhythm. Patients with VF/VT have 10-15 times more chance of surviving than those suffering from pulseless electrical activity or asystole (as they are sensitive to defibrillation, whereas asystole and PEA are not). Pulseless Electrical Activity (also known by the older term Electromechanical Dissociation or Non-Perfusing Rhythm) refers to any heart rhythm observed on the In medicine asystole is a state of no cardiac electrical activity hence no contractions of the Myocardium and no cardiac output or blood flow Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia.

Since mortality in case of OHCA is high, programs were developed to improve survival rate. A study by Bunch et al. showed that, although mortality in case of ventricular fibrillation is high, rapid intervention with a defibrillator increases survival rate to that of patients that did not have a cardiac arrest. Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia. [12][17]

Survival is mostly related to the cause of the arrest (see above). In particular, patients who have suffered hypothermia have an increased survival rate, possibly because the cold protects the vital organs from the effects of tissue hypoxia. Hypothermia is a condition in which an organism's temperature drops below that required for normal Metabolism and bodily functions Survival rates following an arrest induced by toxins is very much dependent on identifying the toxin and administering an appropriate antidote. A patient who has suffered a myocardial infarction due to a blood clot in the left coronary artery has a lower chance of survival as it cuts of the blood supply to most of the left ventricle (the chamber which must pump blood to the whole of the systemic circulation). Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply A thrombus, or blood clot, is the final product of the Blood coagulation step in Hemostasis. The left coronary artery, abbreviated LCA and also known as the left main coronary artery (often abbreviated LMCA) arises from the aorta above the

Cobbe et al (1996) conducted a study into survival rates from out of hospital cardiac arrest. 14. 6% of those who had received resuscitation by ambulance staff survived as far as admission to an acute hospital ward. Of these, 59. 3% died during that admission, half of these within the first 24 hours. 46. 1% survived to hospital discharge (this is 6. 75% of those who had been resuscitated by ambulance staff), however 97. 5% suffered a mild to moderate neurological disability, and 2% suffered a major neurological disability. Of those who were successfully discharged from hospital, 70% were still alive 4 years after their discharge. [18]

Ballew (1997) performed a review of 68 earlier studies into prognosis following in-hospital cardiac arrest. They found a survival to discharge rate of 14% (this roughly double the rate for out of hospital arrest found by Cobbe et al (see above)), although there was a wide range (0-28%). [19]

Prevention

With positive outcomes following cardiac arrest so unlikely, a great deal of effort has been spent in finding effective strategies to prevent cardiac arrest.

As noted above, one of the prime causes of cardiac arrest outside of hospital is ischemic heart disease. Ischaemic or ischemic heart disease (IHD or myocardial ischaemia, is a Disease characterized by reduced blood supply to the heart muscle Vast resources have been put into trying to reduce cardiovascular risks across much of the developed world. In particular schemes have been put in place to promote a healthy diet and exercise. A healthy diet is one that is arrived at with the intent of improving or maintaining optimal Health. For people considered to be particularly at risk of heart disease, measures such as blood pressure control, prescription of cholesterol lowering medications, and other medico-therapeutic interventions, have been widely used. Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories Cholesterol is a Lipid found in the Cell membranes and transported in the Blood plasma of all Animals It is an essential component of mammalian A magnesium deficiency, or lower levels of magnesium, can contribute to heart disease and a healthy diet that contains adequte magnesium may help prevent heart disease. Magnesium deficiency refers to an absolute lack of Magnesium, the result of numerous conditions Magnesium (mægˈniːziəm is a Chemical element with the symbol Mg, Atomic number 12 Atomic weight 24 A healthy diet is one that is arrived at with the intent of improving or maintaining optimal Health. Magnesium (mægˈniːziəm is a Chemical element with the symbol Mg, Atomic number 12 Atomic weight 24 [20] Magnesium can be used to enhance long term treatment, so it may be effective in long term prevention. Magnesium (mægˈniːziəm is a Chemical element with the symbol Mg, Atomic number 12 Atomic weight 24

Patients in hospital are far less likely to have a cardiac arrest caused of primary cardiac origin, and hence present in asystole or PEA, and have bleak outcomes. Extensive research has shown that patients in general wards often deteriorate for several hours or even days before a cardiac arrest occurs[10][21]. This has been attributed to a lack of knowledge and skill amongst ward based staff, in particular a failure to carry out measurement of the respiratory rate, which is often the major predictor of a deterioration[10] and can often change up to 48 hours prior to a cardiac arrest. The respiratory rate (aka respiration rate, pulmonary ventilation rate or ventilation rate) is the number of breaths a living being such as a human takes In response to this, many hospitals now have increased training for ward based staff. A number of "early warning" systems also exist which aim to quantify the risk which patients are at of deterioration based on their vital signs and thus provide a guide to staff. Vital signs are measures of various physiological statistics often taken by Health professionals in order to assess the most basic body functions In addition, specialist staff are being utilised more effectively in order to augment the work already being done at ward level. These include:

Implantable cardioverter defibrillators

A technologically based intervention to prevent further cardiac arrest episodes is the use of an implantable cardioverter-defibrillator (ICD). An implantable cardioverter-defibrillator ( ICD) is a small battery -powered electrical impulse generator which is implanted in patients who are at risk of Sudden This device is implanted in to the patient. They act as an instant defibrillator in the event of arrhythmia. Note that standalone ICDs do not have any pacemaker functions, but they can be combined with a pacemaker, and modern versions also have advanced features such as anti-tachycardic pacing as well as synchronized cardioversion. For other uses see Pacemaker (disambiguation A pacemaker (or artificial pacemaker, so as not to be confused with the heart's natural pacemaker A recent study by Birnie et al. at the University of Ottawa Heart Institute has demonstrated that ICDs are underused in both the United States and Canada. [22] An accompanying editorial by Simpson explores some of the economic, geographic, social and political reasons for this. [23] Patients who are most likely to benefit from the placement of an ICD are those with severe ischemic cardiomyopathy (with systolic ejection fractions less than 30%) as demonstrated by the MADIT-II trial. Cardiomyopathy, which literally means "heart muscle disease" is the deterioration of the function of the Myocardium (i [24]

Ethical issues

Cardiopulmonary resuscitation and advanced cardiac life support are not always in a person's best interest. Advanced cardiac life support or ( ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies as This is particularly true in the case of terminal illnesses when resuscitation will not alter the outcome of the disease. Properly performed CPR often fractures the rib cage, especially in older patients or those suffering from osteoporosis. In Vertebrate Anatomy, ribs ( Latin costae) are the long curved Bones which form the ribcage. Osteoporosis is a Disease of Bone that leads to an increased risk of fracture. Defibrillation, especially repeated several times as called for by ACLS protocols, may also cause electrical burns. Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia. Advanced cardiac life support or ( ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies as

Some people with a terminal illness choose to avoid such measures and die peacefully. Terminal illness is a medical term popularized in the 20th century to describe an active and Malignant Disease that cannot be cured or adequately treated People with views on the treatment they wish to receive in the event of a cardiac arrest should discuss these views with both their doctor and with their family. A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health A patient may ask their doctor to place a do not resuscitate (DNR) order in the medical record. A Do Not Resuscitate, or DNR order is a written order from a doctor that Resuscitation should not be attempted if a person suffers cardiac Alternatively, in many jurisdictions, a person may formally state their wishes in an advance directive or advance health directive. Advance health care directives or advance directives are instructions given by individuals specifying what actions should be taken for their health in the event that they are Advance health care directives or advance directives are instructions given by individuals specifying what actions should be taken for their health in the event that they are

See also

References

  1. ^ a b c Harrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7
  2. ^ Safar P (1986). In medicine asystole is a state of no cardiac electrical activity hence no contractions of the Myocardium and no cardiac output or blood flow Clinical death is the popular term for cessation of blood circulation and breathing Death is the termination of the biological functions that define living Organisms It refers both to a specific Defibrillation is the definitive treatment for the life-threatening Cardiac arrhythmias Ventricular fibrillation and Ventricular tachycardia. Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply Ventricular fibrillation ( V-fib or VF) is a condition in which there is uncoordinated contraction of the Cardiac muscle of the ventricles in the The McGraw-Hill Companies Inc, ( is a Publicly traded corporation headquartered in Rockefeller Center in New York City. "Cerebral resuscitation after cardiac arrest: a review". Circulation 74: IV138-153. Lippincott Williams & Wilkins.  
  3. ^ Holzer M, Behringer W (2005). "Therapeutic hypothermia after cardiac arrest". Current Opinion in Anaestesiology 18: 163-168. Lippincott Williams & Wilkins.  
  4. ^ Safar P et al (1996). "Improved cerebral resuscitation from cardiac arrest in dogs with mild hypothermia plus blood flow promotion". Stroke 27: 105-113. Lippincott Williams & Wilkins.  
  5. ^ Irwin and Rippe's Intensive Care Medicine by Irwin and Rippe, Fifth Edition (2003), Lippincott Williams & Wilkins, ISBN 0-7817-3548-3
  6. ^ Flesche CW, Breuer S, Mandel LP, Breivik H, Tarnow J. Lippincott Williams & Wilkins is an academic and professional medical publisher founded in 1792 and now a part of the Wolters Kluwer group (1994) The ability of health professionals to check the carotid pulse. Circulation Vol. 90: I–288.
  7. ^ F. Javier Ochoa, E. Ramalle-Gomara, J. M. Carpintero et al. (1998) Competence of health professionals to check the carotid pulse. Resuscitation Vol. 37 pp. 173–175
  8. ^ Bahr, J. , Klingler, H. , Panzer, W. , Rode, H. , Kettler, D. (1997). Skills of lay people in checking the carotid pulse. Resuscitation. Vol. 35(1) pp. 23-26
  9. ^ a b c American Heart Association (2005) 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation Vol. 112 pp. 19-34
  10. ^ a b c d e f g Resuscitation Council UK (2005). Resuscitation Guidelines 2005 London: Resuscitation Council UK.
  11. ^ St John Ambulance, St Andrew's Ambulance Association, British Red Cross (2002) (8th Ed. ) First Aid Manual. London: Dorling Kindersley
  12. ^ a b Cardiac Resuscitation Mickey S. Eisenberg, M. D. , Ph. D. , and Terry J. Mengert, M. D. New England Journal of Medicine, Volume 344:1304-1313, April 26, 2001
  13. ^ ACLS: Principles and Practice. The New England Journal of Medicine ( N Engl J Med or NEJM) is an English-language Peer-reviewed Medical journal published p. 71-87. Dallas: American Heart Association, 2003. ISBN 0-87493-341-2.
  14. ^ ACLS for Experienced Providers. p. 3-5. Dallas: American Heart Association, 2003. ISBN 0-87493-424-9.
  15. ^ "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 7. 2: Management of Cardiac Arrest. " Circulation 2005; 112: IV-58 - IV-66.
  16. ^ Lyon, R. M, Cobbe, S. M. , Bradley, J. M. , Grubb, N. R. (2004)Surviving out of hospital cardiac arrest at home: a postcode lottery? Emergency Medical Journal Vol. 21 pp. 619-624
  17. ^ Long-Term Outcomes of Out-of-Hospital Cardiac Arrest after Successful Early Defibrillation T. Jared Bunch, M. D. , Roger D. White, M. D. , Bernard J. Gersh, M. B. , Ch. B. , Ryan A. Meverden, B. S. , David O. Hodge, M. S. , Karla V. Ballman, Ph. D. , Stephen C. Hammill, M. D. , Win-Kuang Shen, M. D. , and Douglas L. Packer, M. D. , New England Journal of Medicine, Volume 348:2626-2633, June 26, 2003
  18. ^ Survival of 1476 patients initially resuscitated from out of hospital cardiac arrest Stuart M Cobbe, Kirsty Dalziel, Ian Ford, Andrew K Marsden, British Medical Journal 1996;312:1633-1637 (29 June)
  19. ^ Recent advances: Cardiopulmonary resuscitation Kenneth A Ballew, British Medical Journal 1997;314:1462 (17 May)
  20. ^ Rosanoff, Andrea (PhD); Seelig, Mildred S (MD) (2004). "Comparison of Mechanism and Functional Effects of Magnesium and Statin Pharmaceuticals". Journal of the American College of Nutrition 23 (5): 501S–505S.  
  21. ^ Kause J, Smith G, Prytherch D, et al. (2004) A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom--the ACADEMIA study. Resuscitation Vol 62 pp. 275-82
  22. ^ Birnie, David H; Sambell, Christie; Johansen, Helen; Williams, Katherine; Lemery, Robert; Green, Martin S; Gollob, Michael H; Lee, Douglas S; Tang, Anthony SL (July 2007). "Use of implantable cardioverter defibrillators in Canadian and IS survivors of out-of-hospital cardiac arrest". Canadian Medical Association Journal 177 (1).  
  23. ^ Simpson, Christopher S (July 2007). "Implantable cardioverter defibrillators work - so why aren't we using them?". Canadian Medical Association Journal 177 (1).  
  24. ^ Moss, AJ; Cannom, DS; Daubert, JP; Hall, WJ; Higgins, SL; Klein, H; Wilber, D; Zareba, W; Brown, MW (1999). "Multicenter automatic defibrillator implantation Trial II (MADIT II) : Design and clinical protocol". Annals of non-invasive electrocardiology 4 (1): 83-91.  

External links

Dictionary

cardiac arrest

-noun

  1. (cardiology, pathology) Sudden and completion cessation of the heartbeat resulting in the loss of effective circulation of the blood.
© 2009 citizendia.org; parts available under the terms of GNU Free Documentation License, from http://en.wikipedia.org
 Dapyx Software network: MP3 Explorer | Ebook Manager | Zenithic