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Cardiac Arrest: Prevalence, Risk Factors and Prevention (pp.159-176) $100.00
Authors:  (Miroslav Sulaj, Department of Anesthesiology and Intensive Medicine, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovakia)
Abstract:
Cardiac arrest (CA) is abrupt loss of heart function, responsible for more than 60% of adult deaths from coronary heart disease. Most CA episodes are caused by the rapid and/or chaotic activity of the heart known as ventricular tachycardia (VT) or ventricular fibrillation (VF), an estimated 95 % of all individuals who suffer CA die before reaching the hospital. The predominant mechanism of cardiac arrest in victims of trauma, drug overdose, drowning, and in many children is asphyxia; rescue breaths are critical for resuscitation of these victims.
Summary data from 37 communities in Europe indicate annual incidence of EMS-treated out-of-hospital cardiopulmonary arrests (OHCAs) for all rhythms 38 per 100,000 individuals. Recent data from 10 North American sites are remarkably consistent with median rate of survival to hospital discharge 8.4%. There is some evidence that long-term survival rates after cardiac arrest are increasing. It is likely that many more victims have VF or rapid ventricular tachycardia (VT) at the time of collapse but, by the time the first electrocardiogram (ECG) is recorded by EMS personnel, the rhythm has deteriorated to asystole. The reported incidence of in-hospital cardiac arrest is more variable, but is in the range of 1–5 per 1000 admissions. Recent data from the American Heart Association’s National Registry of cardiopulmonary resuscitation CPR indicate that survival to hospital discharge after in-hospital cardiac arrest is 17.6% (all rhythms).
Victims of cardiac arrest need immediate CPR. This provides a small but critical blood flow to the heart and brain. It also increases the likelihood that a defibrillator shock will terminate VF and enable the heart to resume an effective rhythm and effective systemic perfusion. Several studies have shown the benefit on survival of immediate CPR, and the detrimental effect of delay before defibrillation. For every minute without CPR, survival from witnessed VF decreases by 7—10%. When bystander CPR is provided, the decline in survival is more gradual and averages 3—4% min−1. Overall, bystander CPR doubles or triples survival from witnessed cardiac arrest. Many victims of CA can survive if bystanders act immediately while VF is still present, but successful
resuscitation is unlikely once the rhythm has deteriorated to asystole. The optimum treatment for VF cardiac arrest is immediate bystander CPR (chest compression combined with rescue breathing) plus electrical defibrillation performed by automatic external defibrillator or implantable cardiac defibrillator.
Resuscitation performance can be improved by adopting innovative training methods, alternative resuscitation protocols that stress cardio-cerebral resuscitation, providing real-time feedback during arrest, and employing a systematic postarrest debriefing process. 


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Cardiac Arrest: Prevalence, Risk Factors and Prevention (pp.159-176)