Cardiac Arrest – Treatment

Cardiac Arrest – Treatment

Question. Write on management of cardiac arrest.

Answer. Cardiac arrest is defied as sudden failure of heartresulting in inadequate cerebral circulation.

Management Cardiac Arrest.

1. Basic life support or Basic cardiac life support

Maintain the airway, breathing and circulation simultaneously as rapidly as possible as follows:

1. Airway: Airway must be patent. If any of the foreign body is suspected, the patient must be rolled on one side and 4–5 forceful blows must be delivered rapidly between the shoulder blades with the heel of the hand.
   Now keep the patient in supine position and abdominal thrusts in an upward direction are given to the patient just below the xiphisternum.
   After the foreign body is excluded, patient should be kept in supine position as he may require external cardiac massage and artifiial respiration.
   The patient’s head should be lifted with one hand under the neck and the other hand pressing the forehead so that the head is tilted backwards to keep the upper airway patent.
2. Breathing: Once the patency of airway is maintained, and if breathing is inadequate, artifiial ventilation must be given. With the above position, the patient’s nostrils must be sealed with thumb and index figer and mouth­to­mouth respiration must be given to the patient.
   This is done by taking a deep inspiration and exhaling in the patient’s mouth and then the patient is allowed to exhale passively.
   Continue this procedure at the rate of 16-18/min. In hospitals, an Ambu bag is used.
3. Circulation: With the patient in supine position, neck extended and legs elevated a sudden sharp thrust is given on the chest wall.
   This may restore the effctive beating of the heart especially, if the cardiac arrest is due to cardiac standstill.
   In absence of response, external cardiac massage is given.

Cardiac Arrest Treatment Options and Protocols

2. Advanced Cardiac Life Support (ACLS)

As the basic life support is maintained an ECG must be taken to determine whether the cause of cardiac arrest is ventricular asystole or ventricular firillation.

1. If it is ventricular asystole, while electric methods of treatment like external cardiac pacemaker are made available, the following drugs are given;

1. Epinephrine (Adrenaline): 1 mL of 1:1000 epinephrine is given intravenous followed by a bolus of dextrose.
2. Calcium: 10 mL calcium gluconate 10% is injected IV or sometimes intracardiac. It is rarely used.
3. Sodium bicarbonate: 10 mL of 7.5% sodium bicarbonate is infused slowly intravenously to correct metabolic acidosis. This is also rarely used.
4. Vasopressors: Nor­epinephrine 1:1000 is initially given in the dose of 2 mL and later repeated, if hypotension persists.

2. lf it is ventricular firillation the following drugs are used in addition:

1. Lignocaine: 50–100 mg is injected intravenously as a bolus and may be repeated after 15–20 min.
2. Propranolol: 5–10 mg may be given intravenously as an antiarrhythmic agent.
3. Bretylium tosylate: It is given as 5 to 10mg/kg IV

2. Specifi measures cardiac arrest.

1. For ventricular asystole: If cardiac arrest persists in spite of the above measures, external cardiac pacing is done.
   If this is negative or required for a long period, internal cardiac pacemaker is inserted.
2. For ventricular firillation: If the above drugs do not immediately revert the cardiac rhythm, or if ventricular firillation is recurrent inspite of the above measures a direct current (DC) shock is given to the heart with 200 joules.
   It should be repeated, if required after a few minutes with 300 V Joules and then up to 400 Joules.

Cardiac Arrest: Emergency Treatment and Management

3. Management after successful resuscitation in an unconscious patient

1. Endotracheal Intubation with controlled ventilation should be continued with the help of a ventilator to keep the partial pressure of oxygen at 100 mm Hg and partial pressure of carbon dioxide at 30-40 mm Hg.
2. Blood pressure must be maintained at 10mm Hg systolic, if required with the help of vasopressors like dopamine.
3. Acid-base and flid electrolyte balance should be maintained.
4. Mannitol 350 to 500 mL I.V. or dexamethasone 4 mg 6 to 8 hourly I.V. should be given in presence of cerebral edema.
5. Phenytoin sodium, diazepam or phenobarbitone should be given if there are convulsions.
6. Aspiration pneumonia should be prevented by appropriate antibiotics.