Cardiac arrest is a medical emergency where the heart stops beating unexpectedly. It requires prompt CPR and defibrillation to reverse the condition if possible. CPR involves chest compressions, rescue breathing, and early defibrillation to restore spontaneous blood circulation and breathing until advanced care is provided. The chain of survival emphasizes immediate recognition, early CPR, rapid defibrillation if needed, advanced life support, and post-cardiac arrest care to optimize survival and neurological outcomes.

1. CARDIAC ARREST AND CPR
ANIE GLADSTIN
MSC NURSING
KIMS COLLEGE OF NURSING

2. INTRODUCTION
Cardiac arrest is a medical emergency that in certain patients it is reversible if
treated early enough.
When unexpected cardiac arrest leads to death it is called Sudden Cardiac Death
(SCD).
Due to inadequate circulation / cerebral perfusion the patient will become
unconscious and have absence of breathing.

3. Cardiac Arrest
• Cardiac arrest describes the sudden and complete loss of cardiac output due to asystole(
cessation of electrical activity), ventricular tachycardia or fibrillation( irregular rapid
heart rate), or loss of mechanical cardiac contraction (pulseless electrical activity).
• The clinical diagnosis is based on the victim being unconscious and pulseless;
breathing stops completely after the cardiac arrest.
• Death is virtually inevitable, unless effective treatment is given promptly.
• Sudden cardiac death (SCD) is usually caused by ventricular arrhythmia and accounts
for 25–30 %of deaths from cardiovascular disease.

4. Definition – Cardiac Arrest
• A cardiac arrest , also known as cardio pulmonary or circulatory arrest is the
abrupt cessation of normal circulation of blood due to failure of the heart to
contract effectively during systole.
• Arrested circulation prevents delivery of oxygen to all parts of the body.
• Cerebral hypoxia causes victims to lose consciousness and cessation of
breathing.
• Brain injury is likely if cardiac arrest is not treated for more than five minutes.

5. Classification
• Based on ECG rhythm , cardiac arrest is classified into ‘shockable’ versus ‘
non shockable’.
• Two shockable rhythms are
- Ventricular fibrillation ( rapid heart beat)
- Pulseless ventricular tachycardia.(rapid heart beat, no time to refill heart,
resulting in undectable pulse.
Two non-shockable rhythms are
- Asystole ( absence of ventricular contraction)
- Pulseless electrical activity (PEA)

6. Signs and symptoms
• Cardiac arrest is an abrupt cessation of the pumping function of the heart manifested by
the absence of a palpable pulse.
• Prompt intervention can usually reverse a cardiac arrest , but without intervention it
will almost always leads to death.
• Due to inadequate cerebral perfusion, patient will be unconscious and will have
stopped breathing.
• The main diagnostic criterion to diagnose a cardiac arrest is absence of carotid pulse
due to lack of circulation.

7. Causes of Cardiac Arrest
• Cardiac causes (65% )
- CAD is the leading cause of sudden cardiac arrest (60- 70%)
- Non ischaemic heart disease – cardiomyopathy , cardiac rhythm
disturbances ,hypertensive heart disease, congestive heart failure.
• Non cardiac causes (35%)
- Trauma and trauma related bleeding
- Drug overdose
- Drowning ( suffocation when water or other liquid fills lungs)
- Pulmonary embolism
- Severe electrolyte imbalances

8. Risk factors
• ‘H’ s and ‘T’s – Reversible and treatable causes of cardiac arrest.
• Hs:- Hypovolemia
- Hypoxia
- Hydrogen ions( acidosis)
- Hyperkalemia /hypokalemia
- Hypothermia
- Hypoglycemia

9. Risk factors
• T’s
- Toxins/ tablets
- Tamponade( compression of heart caused by fluid collecing the sac surrounding the
heart)
- Tension pneumothorax (air is trapped in the pleural cavity)
-Thrombosis (coronary artery)
- Thromboembolism (pulmonary)
- Trauma

10. Diagnosis of cardiac arrest
• Absence of pulse- lack of carotid pulse is the gold standard for diagnosing cardiac
arrest.
• In- Hospital cardiac arrest (IHCA)
• Out- of – Hospital cardiac arrest (OHCA)

11. IHCA (In Hospital Cardiac Arrest)
• Most of the in hospital cardiac arrest is due to respiratory failure, hypovolemic shock which are
manifested by physiological changes such as tachycardia, tachypnoea, hypotension and low O2
saturation .
• - Hospitals have designed systems to identify and treat early clinical deterioration ( worse).

12. Contd….
• The early warning sign system consists of :
- Threatened airway
- Respiratory rate less than 6/ minute or more than 30/ minute.
- Heart rate less than 40 /minute or more than 140/ minute .
- Systolic BP less than 90mm of Hg.
- Symptomatic hypertension
- Unexplained decrease in the level of consciousness
- Unexplained agitation
- Seizures
- Significant fall in urine output
- Subjective concern about the patient.

13. Out- of – Hospital cardiac arrest (OHCA)
• An OHCA is defined as cessation of cardiac mechanical activity that
occurs outside of the hospital setting and is confirmed by the absence
of signs of circulation.

14. Cardiopulmonary resuscitation
• Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines
chest compressions often with artificial ventilation in an effort to manually preserve
intact brain function until further measures are taken to restore spontaneous blood
circulation and breathing in a person who is in cardiac arrest.
• It is recommended in those who are unresponsive with no breathing or abnormal
breathing, for example, agonal respirations.

15. CONTD…
• CPR involves chest compressions for adults between 5 cm to 6 cm ((2.0 to 2.4 inches) . The
rescuer may also provide artificial ventilation by either exhaling air into the subject's mouth or
nose (mouth-to-mouth resuscitation) or using a device that pushes air into the subject's lungs
(bag- mask device, mechanical ventilation).
• Current recommendations place emphasis on early and high-quality chest compressions
over artificial ventilation; a simplified CPR method involving chest compressions only is
recommended for untrained rescuers.

16. Cardiopulmonary Resuscitation
• CPR is a series of lifesaving actions that improve the chance of survival after
cardiac arrest.
• CPR consists of:-
- BLS (Basic Life Support) & ACLS ( Advanced cardiac life support)

17. • Cardiopulmonary resuscitation (CPR) is life saving procedure for a victim who
has signs of cardiac arrest.( unresponsive, no normal breathing, no normal pulse)
• High Quality CPR improves victim’s chances of survival.

18. CPR - OBJECTIVES
• CPR alone is unlikely to restart the heart.
• Its main purpose is to restore partial flow of oxygenated blood to the brain and
heart thereby to delay tissue death and to have successful resuscitation without
permanent brain damage.
• Chest compression to breathing ratio is set at 30 to 2 in adults.

19. CPR - OBJECTIVES
• Defibrillation is effective to revert certain heart rhythms, namely ventricular fibrillation
or pulseless ventricular tachycardia, rather than asystole or pulseless
electrical activity (PEA)
 Early shock when appropriate is recommended.
 CPR may succeed in inducing a heart rhythm that may be shockable.
 CPR is continued until the person has a return of spontaneous circulation (ROSC) or is
declared dead.

20. CPR- INDICATIONS
• Person who is unresponsive with no breathing or breathing only in occasional
agonal gasps, as it is most likely that they are in cardiac arrest.
• If a person still has a pulse but is not breathing (respiratory arrest) artificial ventilations
may be more appropriate.
 As a lay person has difficulty in accurately assessing the presence or absence of a pulse,
CPR guidelines recommend that lay persons should not be instructed to check the pulse,
while giving healthcare professionals the option to check a pulse.
 Persons with cardiac arrest due to trauma.

21. • A universal compression to ventilation ratio of 30:2 is recommended for adults.
• With children, if 2 trained rescuers are present a ratio of 15:2 is preferred.
• The recommended order of interventions is chest compressions, airway, breathing
or CAB in most situations, with a compression rate of at least 100- 120 per minute
in all groups.
• Recommended compression depth in adults and children is at least 5 cm (2 inches)
and in infants 4 cm

22. • Chest Compression Rate
- In adult victims of cardiac arrest, it is reasonable for rescuers to perform chest
compressions at a rate of 100 to 120/min.
 Chest Compression Depth
2015 (Updated): During manual CPR, rescuers should perform chest compressions
to a depth of at least 2 inches (5 cm) for an average adult, while avoiding excessive
chest compression depths (greater than 2.4 inches [6 cm]).

23. High Quality CPR - Characteristics
• Position patient on hard surface in supine position
• Start compressions within 10 seconds of recognition of cardiac arrest.
• Push hard and fast: compress at a rate of 100- 120 / minute with a depth of at least
- 2-2.4 inches (5cm-6cm )for adults
- one third the depth of the chest – 5 cm for children
- one third the depth of the chest –about 4 cm for infants.

24. High Quality CPR – Characteristics-cont…
• Allow complete chest recoil after each compression.( Avoid leaning on
the chest between compressions)
• Minimize interruptions in compressions .
• Ventilate adequately- 2 breaths after 30 compressions; each breath
delivered over one second, each causing chest rise..
• Avoid excessive ventilation.

25. Basic life support
• Basic life support (BLS) is a level of medical care which is used for
victims of life-threatening illnesses or injuries until they can be given full
medical care at a hospital.
• It can be provided by trained medical personnel, including certified,
emergency medical technicians, and by qualified bystanders.

26. BASIC LIFE SUPPORT (BLS)
• BLS assessment for initial evaluation
• Primary assessment-ABCD & E
• Secondary assessment- SAMPLE ( signs and symptoms, Allergies, Medications, Past medical
history relating to current illness, last meal consumed, Events ) and H’s & T’s

27. Primary Assessment
• A- Airway
• B- Breathing
• C – Circulation
• D- Disability- Neurologic function, responsiveness , consciousness and pupil dilation
• E- Exposure- Remove clothing to perform physical examination, signs of trauma,
bleeding , burns, unusual markings, medical alert bracelets.

28. Secondary Assessment
• Includes
- Differential diagnosis
- Focused medical history and searching and treating for underlying causes-H’s & T’s.
- SAMPLE
S- Signs& symptoms
A- Allergies
M- Medications
P- Past medical history
L –Last meal consumed
E- Events

31. CHAIN OF SURVIVAL IN CARDIAC ARREST

33. The chain of survival in OHCA
• Immediate recognition of cardiac arrest and activation of emergency response
system
• Early CPR with an emphasis on chest compressions.
• Rapid defibrillation
• Effective advance life support .( including rapid stabilization and transport to post
cardiac arrest care.)
• Multidisciplinary post- cardiac arrest care.

34. The chain of survival in IHCA
• Surveillance, prevention and treatment of pre arrest conditions.
• Immediate recognition of cardiac arrest and activation of emergency response
system
• Early CPR with an emphasis on chest compressions.
• Rapid defibrillation
• Multidisciplinary post- cardiac arrest care.

39. BLS ASSESSMENT

54. • Immediately after the shock give CPR beginning with compressions.
• Minimizing interruptions:-
• Avoid
- Prolonged rhythm analysis
- Frequent or inappropriate pulse checks
- Taking too long to give breaths to the patient.
- Unnecessarily moving the patient.

59. Post cardiac arrest care