Surgical Critical Care: Cardiac Arrest

Prognosis

• Survival to Discharge:
  • Out-of-Hospital: 10-12%
  • In-Hospital: 20-25%
• Majority of Survivors Have Some Degree of Brain Injury & Impaired Consciousness
• As Seen on TV: Falsely High Expectations for Lay Public
  • 46-75% Survive Immediate Arrest
  • 67% Appear to Survive to Discharge
  • Lacks Depiction of Poor Medium-Long Term Outcomes

Pulseless Electrical Activity (PEA)

• Previously Known as Electromechanical Dissociation (EMD)
• Definition: Sufficient Electrical Discharge without a Palpable Pulse
• Non-Perfusing Rhythm
• Causes: Cardiac Arrest or “5 H’s & 5 T’s”
  • 5 H’s:
    • Hypovolemia
    • Hypoxia
    • Hydrogen Ions (Acidosis)
    • Hypokalemia/Hyperkalemia
    • Hypothermia
  • 5 T’s:
    • Tension Pneumothorax
    • Trauma
    • Tamponade
    • Thrombosis, Pulmonary
    • Thrombosis, Coronary
• Treatment:
  • Initial: Start CPR & Give Oxygen
  • Check Rhythm Every 2 Minutes (Not Shockable Rhythms)
  • Epinephrine Every 3-5 Minutes

Asystole

• EKG Pattern:
  • No Waveform
  • Only an Isoelectric “Flat Line”
• The Terminal Rhythm of Cardiac Arrest
• Non-Perfusing Rhythm
• Treatment:
  • Initial: Start CPR & Give Oxygen
  • Check Rhythm Every 2 Minutes (Not Shockable Rhythms)
  • Epinephrine Every 3-5 Minutes