What are the causes of cardiac arrest?

From the Guidelines

Cardiac arrest is most commonly caused by cardiac issues such as heart attacks, arrhythmias, and heart failure, as well as respiratory, metabolic, and traumatic causes, as highlighted in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. The primary causes of cardiac arrest can be categorized into several key areas, including:

• Cardiac issues: heart attacks (myocardial infarction), arrhythmias (particularly ventricular fibrillation and ventricular tachycardia), and heart failure
• Respiratory causes: severe asthma, pulmonary embolism, airway obstruction, or respiratory failure
• Metabolic disturbances: severe electrolyte imbalances (particularly potassium, calcium, and magnesium), profound acidosis, hypoxia, and hypothermia
• Drug overdoses: particularly from opioids, sedatives, or cardiac medications
• Trauma: especially with significant blood loss or direct cardiac injury
• Septic shock: from severe infections that can progress to cardiovascular collapse Understanding these causes is crucial for prevention and appropriate management, as immediate recognition and intervention with cardiopulmonary resuscitation (CPR), defibrillation when indicated, and addressing the underlying cause are essential for improving survival chances, as emphasized in the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. It is also important to note that the Utstein templates for out-of-hospital cardiac arrest provide a framework for collecting data on cardiac arrest causes, including medical, traumatic, drug overdose, drowning, electrocution, and asphyxial causes, as outlined in the 2015 update of the Utstein resuscitation registry templates 1. Additionally, the ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death highlight the importance of considering reversible causes of cardiac arrest, such as acute ischemia and electrolyte imbalance, as well as the potential role of antiarrhythmic drugs in contributing to cardiac arrest 1.

From the Research

Causes of Patient Arrest

The causes of patient arrest can be attributed to various factors, including:

• Myocardial infarction (MI) and massive pulmonary embolism (MPE) are common causes of cardiac arrest 2, 3, 4, 5
• Imbalanced immune response, which is a crucial component of post-cardiac arrest syndrome 6
• Cardiogenic shock in the context of acute ST-elevation myocardial infarction (STEMI) 3
• Coagulation activation after cardiac arrest, which can lead to microcirculatory reperfusion disorders 4

Specific Causes

Some specific causes of patient arrest include:

• Acute myocardial infarction (MI) 2, 3, 4, 5
• Massive pulmonary embolism (MPE) 2, 4, 5
• ST-elevation myocardial infarction (STEMI) 3, 5
• Cardiogenic shock 3
• Pulmonary embolism (PE) 4, 5

Diagnostic Clues

Diagnostic clues for distinguishing between different causes of cardiac arrest include:

• Initial rhythm, such as pulseless electrical activity (PEA) or ventricular fibrillation (VF) 2
• Electrocardiogram (EKG) findings, such as ST segment elevations (STEs) 2, 3, 5
• Coronary angiogram results 2, 3
• Echocardiogram results 2
• Point-of-care ultrasound (PoCUS) in the emergency department (ED) 5