Cardiac arrest

For other uses, see Cardiac arrest (disambiguation).
Not to be confused with heart failure or myocardial infarction.

Cardiac arrest
Other namesCardiopulmonary arrest, circulatory arrest, sudden cardiac arrest (SCA)[1]
CPR being administered during a simulation of cardiac arrest
SpecialtyCardiology, emergency medicine
SymptomsDecreased level or total loss of consciousness, abnormal or no breathing, no pulse[1][2]
ComplicationsIf reversed, coma, persistent vegetative state, post-cardiac arrest syndrome; if not reversed, death
Usual onsetThe risk of onset increases with age[3]
CausesCoronary artery disease, congenital heart defect, major blood loss, lack of oxygen, electrical injury, very low potassium, heart failure, myocardial infarction
Diagnostic methodFinding no pulse,[1] ECG (EKG)[4]
PreventionNot smoking, physical activity, maintaining a healthy weight, healthy eating[5]
TreatmentCardiopulmonary resuscitation (CPR), defibrillation[6]
PrognosisOverall survival rate ≈10% (outside of hospital) 25% (in hospital);[7][8] depends strongly on type and cause
Frequency13 per 10,000 people per year (outside hospital in the US)[9]
Deaths> 425,000 per year (U.S.)[10]

Cardiac arrest, also known as sudden cardiac arrest (SCA),[11] is when the heart suddenly and unexpectedly stops beating.[12][1] When the heart stops beating, blood cannot properly circulate around the body and the blood flow to the brain and other organs is decreased. When the brain does not receive enough blood, this can cause a person to lose consciousness and brain cells can start to die due to lack of oxygen.[13] Coma and persistent vegetative state may result from cardiac arrest. Cardiac arrest is also identified by a lack of central pulses and abnormal or absent breathing.[1]

Cardiac arrest and resultant hemodynamic collapse often occur due to arrhythmias (irregular heart rhythms). Ventricular fibrillation and ventricular tachycardia are most commonly recorded.[14] However, as many incidents of cardiac arrest occur out-of-hospital or when a person is not having their cardiac activity monitored, it is difficult to identify the specific mechanism in each case.

Structural heart disease, such as coronary artery disease, is a common underlying condition in people who experience cardiac arrest. The most common risk factors include age and cardiovascular disease.[15] Additional underlying cardiac conditions include heart failure and inherited arrhythmias. Additional factors that may contribute to cardiac arrest include major blood loss, lack of oxygen, electrolyte disturbance (such as very low potassium), electrical injury, and intense physical exercise.[16]

Cardiac arrest is diagnosed by the inability to find a pulse in an unresponsive patient.[4][1] The goal of treatment for cardiac arrest is to rapidly achieve return of spontaneous circulation using a variety of interventions including CPR, defibrillation, and/or cardiac pacing. Two protocols have been established for CPR: basic life support (BLS) and advanced cardiac life support (ACLS).[17]

If return of spontaneous circulation is achieved with these interventions, then sudden cardiac arrest has occurred. By contrast, if the person does not survive the event, this is referred to as sudden cardiac death. Among those whose pulses are re-established, the care team may initiate measures to protect the person from brain injury and preserve neurological function.[18] Some methods may include airway management and mechanical ventilation, maintenance of blood pressure and end-organ perfusion via fluid resuscitation and vasopressor support, correction of electrolyte imbalance, EKG monitoring and management of reversible causes, and temperature management. Targeted temperature management may improve outcomes.[19][20] In post-resuscitation care, an implantable cardiac defibrillator may be considered to reduce the chance of death from recurrence.[5]

Per the 2015 American Heart Association Guidelines, there were approximately 535,000 incidents of cardiac arrest annually in the United States (about 13 per 10,000 people).[9] Of these, 326,000 (61%) experience cardiac arrest outside of a hospital setting, while 209,000 (39%) occur within a hospital.[9]

Cardiac arrest becomes more common with age and affects males more often than females.[3] Black people are twice as likely to die from cardiac arrest as white people. Asian and Hispanic people are not as frequently affected as white people.[3]

  1. ^ a b c d e f Field JM (2009). The Textbook of Emergency Cardiovascular Care and CPR. Lippincott Williams & Wilkins. p. 11. ISBN 9780781788991. Archived from the original on 2017-09-05.
  2. ^ "Cardiac Arrest - Symptoms | NHLBI, NIH". www.nhlbi.nih.gov. 27 May 2022. Retrieved 20 September 2023.
  3. ^ a b c "Cardiac Arrest - Causes and Risk Factors | NHLBI, NIH". www.nhlbi.nih.gov. 19 May 2022. Retrieved 30 September 2023.
  4. ^ a b "Cardiac Arrest - Diagnosis | NHLBI, NIH". National Heart, Lung, and Blood Institute, US National Institutes of Health. 19 May 2022. Retrieved 3 October 2022.
  5. ^ a b "How Can Death Due to Sudden Cardiac Arrest Be Prevented?". NHLBI. June 22, 2016. Archived from the original on 27 August 2016. Retrieved 16 August 2016.
  6. ^ "Cardiac Arrest - Treatment". National Heart, Lung, and Blood Institute, US National Institutes of Health. 19 May 2022. Retrieved 24 July 2022.
  7. ^ Adams JG (2012). Emergency Medicine: Clinical Essentials (Expert Consult – Online). Elsevier Health Sciences. p. 1771. ISBN 978-1455733941. Archived from the original on 2017-09-05.
  8. ^ Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A (March 2019). "In-Hospital Cardiac Arrest: A Review". JAMA. 321 (12): 1200–1210. doi:10.1001/jama.2019.1696. PMC 6482460. PMID 30912843.
  9. ^ a b c Kronick SL, Kurz MC, Lin S, Edelson DP, Berg RA, Billi JE, et al. (November 2015). "Part 4: Systems of Care and Continuous Quality Improvement: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 132 (18 Suppl 2): S397–S413. doi:10.1161/cir.0000000000000258. PMID 26472992. S2CID 10073267.
  10. ^ Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, et al. (July 2013). "Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association". Circulation. 128 (4): 417–435. doi:10.1161/CIR.0b013e31829d8654. PMID 23801105.
  11. ^ Patil KD, Halperin HR, Becker LB (2015-06-05). "Cardiac Arrest: Resuscitation and Reperfusion". Circulation Research. 116 (12): 2041–2049. doi:10.1161/CIRCRESAHA.116.304495. ISSN 0009-7330. PMC 5920653. PMID 26044255.
  12. ^ "Cardiac Arrest - What Is Cardiac Arrest? | NHLBI, NIH". www.nhlbi.nih.gov. 19 May 2022. Retrieved 20 September 2023.
  13. ^ "Cardiac Arrest - What Is Cardiac Arrest? | NHLBI, NIH". www.nhlbi.nih.gov. 2022-05-19. Retrieved 2024-10-20.
  14. ^ Bayés de Luna A, Coumel P, Leclercq JF (January 1989). "Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases". American Heart Journal. 117 (1): 151–159. doi:10.1016/0002-8703(89)90670-4. PMID 2911968.
  15. ^ Cite error: The named reference Goldenberg_2003 was invoked but never defined (see the help page).
  16. ^ Zheng ZJ, Croft JB, Giles WH, Mensah GA (October 2001). "Sudden cardiac death in the United States, 1989 to 1998". Circulation. 104 (18): 2158–2163. doi:10.1161/hc4301.098254. PMID 11684624.
  17. ^ ECC Committee, Subcommittees and Task Forces of the American Heart Association (December 2005). "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 112 (24 Suppl): IV1-203. doi:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375.
  18. ^ Neumar RW, Nolan JP, Adrie C, Aibiki M, Berg RA, Böttiger BW, et al. (December 2008). "Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council". Circulation. 118 (23): 2452–2483. doi:10.1161/CIRCULATIONAHA.108.190652. PMID 18948368.
  19. ^ Schenone AL, Cohen A, Patarroyo G, Harper L, Wang X, Shishehbor MH, et al. (November 2016). "Therapeutic hypothermia after cardiac arrest: A systematic review/meta-analysis exploring the impact of expanded criteria and targeted temperature". Resuscitation. 108: 102–110. doi:10.1016/j.resuscitation.2016.07.238. PMID 27521472.
  20. ^ Arrich J, Schütz N, Oppenauer J, Vendt J, Holzer M, Havel C, Herkner H (May 2023). "Hypothermia for neuroprotection in adults after cardiac arrest". The Cochrane Database of Systematic Reviews. 5 (5): CD004128. doi:10.1002/14651858.CD004128.pub5. PMC 10202224. PMID 37217440.