What are the causes of cardiac arrest?

From the Guidelines

Patient arrest, or cardiac arrest, is primarily caused by cardiac issues such as heart attacks, arrhythmias, and heart failure, as well as respiratory problems, metabolic disturbances, drug overdoses, trauma, and other conditions that disrupt normal physiological functions, as highlighted in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. The main 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 problems: 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 severe blood loss, tension pneumothorax, or cardiac tamponade
• Other conditions: sepsis, anaphylaxis, and neurological catastrophes like massive strokes or intracranial hemorrhage According to the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, cardiac arrest can be caused by 4 rhythms: ventricular fibrillation (VF), pulseless ventricular tachycardia (VT), pulseless electric activity (PEA), and asystole 1. The 2006 ACC/AHA/ESC guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death also highlight the importance of identifying and treating underlying causes of cardiac arrest, including cardiac issues, electrolyte imbalances, and drug-induced QT prolongation 1. The Utstein templates for out-of-hospital cardiac arrest, updated in 2015, provide a framework for collecting data on cardiac arrest causes, including medical, traumatic, drug overdose, drowning, electrocution, and asphyxial causes 1. Overall, understanding the causes of cardiac arrest is crucial for prevention and appropriate management, as identifying the underlying etiology guides resuscitation efforts and post-arrest care.

From the Research

Causes of Patient Arrest

The causes of patient arrest are not explicitly stated in the provided studies, but the studies discuss the management and treatment of cardiac arrest.

Medications Used in Cardiac Arrest

• Epinephrine is a core component of guidelines for cardiac arrest management, with a recommended dose of 1 mg in patients with shockable rhythms if initial CPR and defibrillation are unsuccessful 2.
• The combination of vasopressin, steroids, and epinephrine may improve return of spontaneous circulation (ROSC) among patients with in-hospital cardiac arrest 2.
• Antiarrhythmics, such as amiodarone and lidocaine, may be used in patients with cardiac arrest and refractory pulseless ventricular tachycardia (pVT)/ventricular fibrillation (VF) 2, 3, 4.
• Calcium and sodium bicarbonate should not be routinely administered in patients with cardiac arrest 2.
• Beta-blockers may be considered in patients with shock-resistant pVT/VF 2.

Effectiveness of Medications

• Epinephrine may improve short-term survival, but its use has been questioned due to potential harmful effects on microvascular blood flow during and after CPR 5, 6.
• Amiodarone and lidocaine have been shown to be equivalent in terms of survival at hospital discharge, but may improve hospital admission rates 4.
• The use of medications in cardiac arrest management should be based on evidence-based updates and guidelines 2, 3, 5.