What are the causes and treatment options for cardiac arrest (sudden cardiac arrest)?

From the Guidelines

Cardiac arrest requires immediate action, and the most effective treatment is high-quality cardiopulmonary resuscitation (CPR) with early defibrillation, as emphasized in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. The causes of cardiac arrest can be diverse, including ventricular fibrillation, pulseless ventricular tachycardia, and nonshockable rhythms, and it is critical to recognize that all cardiac arrest events are not identical, requiring specialized management for optimal patient outcome 1. Some key points to consider in the treatment of cardiac arrest include:

• Performance of high-quality CPR, which includes adequate compression depth and rate while minimizing pauses in compressions 1
• Early defibrillation with concurrent high-quality CPR for survival when sudden cardiac arrest is caused by ventricular fibrillation or pulseless ventricular tachycardia 1
• Administration of epinephrine with concurrent high-quality CPR to improve survival, particularly in patients with nonshockable rhythms 1
• Prompt initiation of targeted temperature management for all patients who do not follow commands after return of spontaneous circulation to ensure optimal functional and neurological outcome 1
• Accurate neurological prognostication in brain-injured cardiac arrest survivors to ensure that patients with significant potential for recovery are not destined for certain poor outcomes due to care withdrawal 1 The mainstay of care for cardiac arrest remains the activation of the emergency response systems and performance of high-quality CPR, with a comprehensive, structured, multidisciplinary system required for optimal patient outcomes 1.

From the FDA Drug Label

Cardiovascular manifestations are usually depressant and are characterized by bradycardia, hypotension, and cardiovascular collapse, which may lead to cardiac arrest. If not treated immediately, both convulsions and cardiovascular depression can result in hypoxia, acidosis, bradycardia, arrhythmias and cardiac arrest. If cardiac arrest should occur, standard cardiopulmonary resuscitative measures should be instituted

The causes of cardiac arrest include cardiovascular collapse, bradycardia, hypotension, convulsions, and cardiovascular depression. Treatment options for cardiac arrest include:

• Standard cardiopulmonary resuscitative measures
• Endotracheal intubation
• Administration of oxygen
• Administration of intravenous fluids
• Administration of a vasopressor (e.g., ephedrine) as directed by the clinical situation 2 2

From the Research

Causes of Cardiac Arrest

• Cardiac arrest is a common medical emergency that usually occurs suddenly and results in irreversible brain damage unless prompt, effective treatment is instituted 3
• The exact cause of cardiac arrest is not specified in the provided studies, but it is mentioned that cardiac arrest can be caused by ventricular tachycardia or ventricular fibrillation (VT/VF) 4
• Pulmonary embolism or acute myocardial infarction can also be the cause of cardiac arrest, in which case thrombolytic therapy during cardiopulmonary resuscitation may be beneficial 5

Treatment Options for Cardiac Arrest

• One plan for dealing effectively with cardiac arrest consists of seven steps of cardiopulmonary resuscitation:
  • establishing the diagnosis and deciding whether to resuscitate
  • administering a precordial thump, noting the time and summoning aid
  • establishing a patent airway and performing artificial ventilation and external cardiac compression
  • instituting general supportive measures
  • diagnosing the cardiac arrhythmia responsible for the arrest
  • treating the arrhythmia
  • managing the patient after resuscitation 3
• The American Heart Association (AHA) published guidelines in 2010 that place significant emphasis on 5 major areas of therapy in patients with cardiac arrest, including immediate recognition and activation of the emergency response team, effective chest compressions, rapid defibrillation, effective advanced life support (ALS), and integrated postresuscitation care 6
• Advanced life support encompasses the placement of an advanced airway, establishment of parenteral access, and the administration of cardioactive medications such as epinephrine, vasopressin, atropine, lidocaine, and amiodarone 6
• Amiodarone and lidocaine are two principal medications used in Advanced Cardiac Life Support cardiac arrest algorithm, with lidocaine being associated with statistically significantly higher odds of return of spontaneous circulation (ROSC), 24-hour survival, survival to hospital discharge, and favorable neurologic outcome compared to amiodarone 4
• An early invasive approach to coronary reperfusion with percutaneous coronary intervention, together with active targeted temperature management and optimization of hemodynamic, ventilator, and metabolic parameters, may improve survival and neurologic outcomes in cardiac arrest survivors 7
• Epinephrine still represents the first-line vasopressor during cardiopulmonary resuscitation, while arginine vasopressin may be considered in patients presenting with asystole or who are unresponsive to initial treatment with epinephrine 5