Cardiovascular Critical Care II
iii.
Survival requires both BLS and ACLS. Foundation of ACLS is high-quality BLS. In addition
to CPR, the only proven rhythm-specific therapy that increases survival at hospital discharge is
defibrillation of VF/pVT.
iv.
Medications have not consistently been shown to increase survival of cardiac arrest but have
been shown to increase the rate of ROSC or survival to hospital admission (Resuscitation
2010;81:182-6; Med J Aust 2006;185:135-9; Resuscitation 2000;45:161-6; N Engl J Med
1999;341:871-8).
| (a) | Vascular access and medication delivery should never interrupt CPR and/or defibrillation. |
|---|
All other therapies are “considerations” and should never compromise chest compressions.
| (b) | If interruptions in chest compressions are necessary (e.g., rhythm assessment, delivery of |
|---|
defibrillation shocking in VF/VT), recommendation is to minimize duration (less than 10
seconds).
During cardiac arrest treatment, it is imperative to evaluate, treat, and/or reverse any treatable
causes of cardiac arrest (Table 2).
vi.
Post–cardiac care should begin immediately after ROSC is obtained to avoid re-arrest.
H’s
T’s
Hypoxia
Toxins
Hypovolemia
Tamponade (cardiac)
Hydrogen ion (acidosis)
Thrombosis
| • | Pulmonary embolism |
|---|---|
| • | Coronary thrombosis |
Hypoglycemia
Hypo/hyperkalemia
Tension pneumothorax
Hypothermia
Patient Case
V.B., a 62-year-old man with an unknown medical history, comes to your ED altered and incoherent. He is
admitted to the ED for observation, where he suddenly becomes unconscious and pulseless. The ED staff
immediately initiates CPR for V.B., who is found to be in PEA. Which statement best describes appropriate
cardiac arrest treatment?
line placement take priority over CPR.
tests are sent.