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Cardiac Arrest Management

  • Ronny M. OteroEmail author
Chapter

Abstract

It is currently estimated that over 300,000 out-of-hospital cardiac (OHCA) arrests occur in the United States. Over half of OHCA cases are managed by EMS systems (Daya et al. Resuscitation 91:108–115, 2015). The national average for survival from an OHCA is approximately 12 % however; there is considerable variation by region and EMS system (Prevention, C.f.D.C.a., Cardiac Arrest Registry to Enhance Survival (CARES) National Summary Report: Non-Traumatic National Survival Report, 2014; Abella et al. Circulation 111:428–434, 2005). Factors associated with an improved survival from OHCA include crew witnessed arrest and bystander CPR (Hollenberg et al. Circulation 118:389–396, 2008). Survival from witnessed VF arrest decreases by 8 % for every minute delay in CPR and defibrillation (Sutton et al. Emerg Med Clin N Am 30(1):105–122, 2012). Overall outcomes correlate with early implementation of chest compression. There is a strong suggestion that bystander CPR whether with “chest compression only” or standard CPR is associated with better mortality and neurologic outcomes (Bernard and Buist Crit Care Med 31(7):2041–2051, 2003; Bohm et al. Resuscitation 82:1490–1495, 2011).

Early effective chest compressions and attention to basic life support components are part of high quality CPR. Various organizations have revisited each of the components of cardiac arrest resuscitation over the last couple of years and thus the elements of high-quality CPR are “ever-evolving” (Hazinski et al. Circulation 132:S2–S39, 2015). Rapid activation of the “Chain of Survival” and meticulous attention to early defibrillation and chest compressions may lead to greater overall trends in survival.

Keywords

Cardiac arrest Mechanical chest compression Coronary perfusion pressure High Performance CPR Termination of resuscitation Hemodynamic directed resuscitation 

Supplementary material

Video 1.1

This is a parasternal long axis view of a patient with cardiac tamponade physiology. Fluid in the anterior pericardial space is compressing the right ventricle during diastole. This is demonstrated by the mitral valves opening as the right ventricle is being compressed (Courtesy of Drs. Kessler, Theyyuni and Huang – University of Michigan Department of Emergency Medicine – Division of Ultrasound) (MP4 2280 kb)

Video 1.2

This is a parasternal short axis view demonstrating an overloaded right ventricle which is pushing the intra-ventricular septum towards the left ventricle which is the lower chamber and causing a “D”-like appearance of the left ventricle rather than a normal “oval” or “circular appearance” (Courtesy of Drs. Kessler, Theyyuni and Huang – University of Michigan Department of Emergency Medicine – Division of Ultrasound) (MP4 848 kb)

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Emergency MedicineUniversity of Michigan HospitalAnn ArborUSA

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