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Cardiopulmonary Resuscitation

Cardiac arrestCardiac arrest is an absolute emergency because the obstruction of the blood flow for 3-5 minutes is enough to cause irreversible brain damage. In this time, the diagnosis must be put, the gestures of resuscitation and life support insurance, followed by obtaining a spontaneous cardiac activity.

In all cases, it is required the intervention of a medical team capable of providing advanced life support. Survival depends on a real chain of survival consisting of the following elements:

• Rapid Alert of the Emergency Service

• Basic cardiopulmonary resuscitation performed by witnesses of the cardiac arrest

• Rapid defibrillation to restore an efficient heart rhythm

• Advanced cardiopulmonary resuscitation.

Support and medical materials needed

To be effective, basic cardio-pulmonary resuscitation does not require private medical facilities. To avoid contact with the patient during resuscitation mouth to mouth, the use of protective fields may be considered (handkerchief, gauze).

Protocol and implementation of the plan requires advanced cardiovascular support:

• external electric defibrillator (automatic or manual), with heart rate monitor option.

• vasoactive medication, antiarrhythmic and supportive of volume expansion.

• Materials for venous and arterial approach,  infusion bags.

• Materials for endotracheal intubation, for suction and ventilation.

Clinical context and confirmation of the diagnosis

Diagnosis of the cardiac arrest is clinical: circulatory arrest is confirmed by the absence of femoral or carotid pulse, leading to the onset of resuscitation, and regarding the respiratory function apnea or gasping may appear. Cardiac arrest leads to complete loss of consciousness, pallor and / or cyanosis, with no reaction (sometimes convulsions) and mydriasis. In pre-hospital, cardiopulmonary arrest confirmation and starting the maneuvers of basic life support are determined by the absence of consciousness, absence of vital signs and the absence of effective breath. 82.4% of cases of cardiopulmonary arrests outside the hospital are due to cardiovascular diseases. Accidents including cases of trauma, asphyxia, drowning, poisoning and various other causes determine cardiorespiratory arrest of non-cardiac cause. 8.6% of the cases of cardiac arrest outside the hospital occur due to endogenous non-cardiac diseases: lung, cerebrovascular, renal neoplasia, gastrointestinal bleeding, diabetes, epilepsy and obstetric causes.

Therapeutic protocol

external thoracic compressionsOutside the hospital, the person who encounters cardiopulmonary arrest must inform the emergency services. In parallel, the procedures for providing vital support basal must be started immediately, by any witness who knows resuscitation maneuvers or is able to perform them based on instructions received from the emergency dispatcher on the phone.

Maneuvers to provide basic life support are made according to the algorithm A, B, C:

A: airway – releasing the airways by hyperextension of the head, raising the jaw and opening the mouth (if cardiac arrest is favored by airway obstruction by a foreign body, its extraction is tried if visible).

B: breathing – start mouth-to-mouth or, if possible, mask ventilation on external according to the sequence of external thoracic compressions 30: 2.

C: circulation – external thoracic compressions performed with a frequency of 100-120 compressions per minute.

In the hospital or when the emergency team arrives it is proceeded to advanced resuscitation which  requires  the intervention of a team prepared with the necessary equipment and medicines. Ventricular fibrillation/pulseless ventricular tachycardia are a common circulatory arrest rhythm in adults and especially patients with cardiovascular disease, with high chances of survival, so that the heart rate analysis is essential to achieve rapid defibrillation by external electric shock.

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