Supportive data for advanced cardiac life support in adults with sudden cardiac arrest
- Charles N Pozner, MD
Charles N Pozner, MD
- Associate Professor of Medicine
- Harvard Medical School
- Mark S Link, MD
Mark S Link, MD
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Tufts Medical School
- Section Editors
- Ron M Walls, MD, FRCPC, FAAEM
Ron M Walls, MD, FRCPC, FAAEM
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Adult Resuscitation
- Neskey Family Professor of Emergency Medicine
- Harvard Medical School
- Brigham and Women's Hospital
- Richard L Page, MD
Richard L Page, MD
- Section Editor — Cardiac Arrhythmias
- Chair, Department of Medicine
- University of Wisconsin, School of Medicine and Public Health
Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) refer to the sudden cessation of cardiac activity with hemodynamic collapse, often due to sustained ventricular tachycardia/ventricular fibrillation. Other causes of SCA and SCD are asystole and pulseless electrical activity. These events most commonly occur in patients with structural heart disease (that may not have been previously diagnosed), particularly coronary heart disease. (See "Pathophysiology and etiology of sudden cardiac arrest".)
The event is referred to as SCA (or aborted SCD) if an intervention (eg, defibrillation) results in the return of spontaneous circulation (ROSC) and restored circulation. The event is called SCD if the patient dies. However, the use of SCD to describe both fatal and nonfatal cardiac arrest persists by convention. (See "Overview of sudden cardiac arrest and sudden cardiac death", section on 'Definitions'.)
The treatment of SCA consists of emergent resuscitation followed, in survivors, by immediate postresuscitative care and attempted long-term prevention of recurrence using pharmacologic and nonpharmacologic interventions. Over time, cardiopulmonary resuscitation (CPR) performed by bystanders has increased, and the interval between collapse and defibrillation has decreased [1,2]. Despite these improvements as well as advances in the treatment of heart disease, the outcome of patients experiencing SCA remains poor. (See "Prognosis and outcomes following sudden cardiac arrest in adults".)
In general, there are two first-line therapies of resuscitation that have been shown to be associated with improved survival: excellent chest compressions and early defibrillation. Resuscitation should focus on these two elements. This is not to say that advanced cardiac life support (ACLS) therapies should be withheld if considered and indicated; however, if a shockable rhythm has not been identified and defibrillated, and/or excellent CPR is not being performed, any other non-scientifically supported interventions should be delayed until these first-line therapies are implemented. In general, the performance of the second-line interventions (as part of ACLS) should almost never interfere with defibrillation and excellent CPR.
Another therapy that has shown a neurologically-favorable survival advantage is targeted temperature management (TTM). This is discussed in greater detail separately. (See 'Targeted temperature management' below and "Post-cardiac arrest management in adults", section on 'Temperature management and therapeutic hypothermia (TH)'.)
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- VF AND PULSELESS VT
- - Timing
- - Defibrillatory waveforms
- VF or VT arrest and vasopressors
- Antiarrhythmic drugs
- - Amiodarone
- - Lidocaine
- - Comparison of amiodarone and lidocaine
- - Magnesium sulfate
- Targeted temperature management
- PULSELESS ELECTRICAL ACTIVITY
- PEA and vasopressors
- PEA and atropine
- Asystole and vasopressors
- - Epinephrine
- - Vasopressin
- Asystole and atropine
- INEFFECTIVE THERAPIES
- SUMMARY AND RECOMMENDATIONS