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KEY POINTS

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  • Most cardiac arrests in the community setting occur as a result of coronary artery disease and cardiac ischemia.

  • Given the high mortality of cardiac arrest, prevention is crucial.

  • Cardiopulmonary resuscitation and rapid defibrillation are the keys to successful resuscitation from cardiac arrest.

  • Advanced Cardiopulmonary Life Support (ACLS) guidelines provide treatment algorithms for the different cardiac rhythms of arrest.

  • Automatic external defibrillators provide a means for rapid defibrillation by the public.

  • High-quality CPR and prompt defibrillation when appropriate are the only proven therapies to increase survival from cardiac arrest.

  • Rapid response teams have been developed to help decrease the incidence of in-hospital cardiac arrest.

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Cardiac arrest, defined as the sudden complete loss of cardiac output and therefore blood pressure, is the leading cause of death in the United States and much of the developed world, claiming at least 300,000 lives each year in the United States alone.1 In the majority of cases, myocardial ischemia in the setting of coronary artery disease represents the underlying etiology of arrest. Conversely, cardiac arrest is the initial presentation of myocardial ischemia in approximately 20% of patients.2 A wide variety of other processes can lead to cardiac arrest, including septic shock, electrolyte abnormalities, hypothermia, pulmonary embolism, and massive trauma (Table 25-1).

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Table Graphic Jump Location
TABLE 25-1

Etiologies of Cardiac Arrest

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Survival from cardiac arrest remains dismal, even after the introduction of electrical defibrillation and cardiopulmonary resuscitation (CPR) over 50 years ago. In the best cases (witnessed ventricular fibrillation arrest with rapid defibrillation), survival to hospital discharge ranges from 30% to 46%,3,4 although overall out-of-hospital arrest survival is usually much lower, ranging from 2% to 26%.5 In large American cities, out-of-hospital arrest survival may be even worse—survival rates of 1.4% and 1.8% have been reported for New York and Chicago, respectively.6-8 Even after successful resuscitation from cardiac arrest, most patients die within 24 to 48 hours despite aggressive intensive care treatment. Reperfusion injury, a subject of much basic science investigation, is thought to be involved in this postarrest deterioration.9,10

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Demographic data from multiple studies demonstrate that ...

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