Cardiac Resuscitation

Cardiac arrest is an ‘arrest’ in the activity of the heart - the heart has stopped beating
notion image

Common Causes

Cardiac

  • Acute myocardial infarction
  • Arrhythmias (VT/VF)
  • Heart failure
  • Cardiomyopathy
  • Severe electrolyte disturbances (K⁺, Mg²⁺)
  • Drug toxicity (e.g., digoxin, cocaine)

Non-Cardiac

  • Hypoxia
  • Hypovolemia
  • Tension pneumothorax
  • Cardiac tamponade
  • Pulmonary embolism
  • Hypothermia
  • Sepsis

Reversible Causes – The H’s & T’s

H’s

  1. Hypovolemia
  1. Hypoxia
  1. Hydrogen ion (acidosis)
  1. Hypo-/Hyperkalemia
  1. Hypothermia

T’s

  1. Tension pneumothorax
  1. Tamponade (cardiac)
  1. Toxins/poisoning/drugs
  1. Thrombosis (coronary)
  1. Thrombosis (pulmonary)

Recognizable Features

  • Unresponsive
  • No breathing or only gasping (agonal respiration)
  • No pulse (carotid or femoral)

Management (ACLS Algorithm)

Immediate Actions

  1. Check responsiveness and breathing
  1. Call for help/activate EMS
  1. Start CPR:
      • Rate: 100–120x/min
      • Depth: 5–6 cm
      • Allow full recoil, minimize interruptions
      • Ratio: 30 compressions : 2 breaths (if no advanced airway)
  1. Attach AED/defibrillator as soon as available

Shockable Rhythms (VF/pVT)

  • Defibrillate immediately
  • Resume CPR for 2 min after shock
  • Epinephrine 1 mg IV every 3–5 min
  • Amiodarone 300 mg IV (first dose), then 150 mg (second dose)
  • Consider reversible causes

Non-Shockable Rhythms (Asystole/PEA)

  • Continue high-quality CPR
  • Epinephrine 1 mg IV every 3–5 min
  • No defibrillation indicated
  • Identify and treat H’s and T’s

Return of Spontaneous Circulation (ROSC)

Post-resuscitation care

  • Maintain oxygenation (SpO₂ 92–98%)
  • Stabilize blood pressure (MAP ≥65 mmHg)
  • Treat underlying cause
  • Consider targeted temperature management (32–36°C for 24 h)
  • Continuous cardiac monitoring