II. Conditions
- Cardiopulmonary Arrest
- Arrhythmia
- Pulseless Electrical Activity
- Ventricular Tachycardia
- Ventricular Fibrillation
- Supreventricular Tachycardia
III. Background
- Mnemonic: 6H 6T
IV. Causes: Six H's
V. Causes: Six T's
- Tablets or Toxins (Unknown Ingestion)
- Tamponade (Cardiac Tamponade)
- Tension Pneumothorax
- Thrombosis: Myocardial Infarction
- Thrombosis: Pulmonary Embolism
- Trauma
VI. Causes: Other
-
Subarachnoid Hemorrhage (5% of Cardiac Arrests)
- Cardiac Arrest triggered by Catecholamine surge with Macrophage infiltration into left ventricle
VII. Imaging: Bedside Ultrasound
- See Echocardiogram
- Precautions
- Ultrasound during pulse checks doubles the time without Chest Compressions
- Have staff count down during pulse check from 10 to 0, and remove Ultrasound probe at 2
- Consider recording a 6 second Ultrasound video that can be reviewed after Chest Compressions resume
- Avoid using with each pulse check (only use with specific goal, e.g. confirm Asystole)
-
General Ultrasound Findings of reversible cause
- Cardiac Tamponade
- Hypovolemia
- Small left ventricle
- Narrow inferior vena cava
- Tension Pneumothorax
- B-Line artifacts may be difficult to see in Cardiac Arrest (may see during Chest Compressions, ventilations)
- Myocardial Infarction
- Regional wall motion abnormalities may be seen in Peri-Arrest patients
- Pulmonary Embolism
- Right ventricular dilatation is non-specific but may indicate Pulmonary Embolism
- Clot in transit (seen in cardiac chambers) is assumed to be associated with Pulmonary Embolism
- Consider Focused Lower Extremity Venous Ultrasound (2 point) for DVT
- Hemorrhagic Shock (e.g. Ruptured Abdominal Aortic Aneurysm, Trauma)
- Cardiac activity definition
- Intrinsic myocardial movement
- Isolated cardiac valve movement occurs with minimal Fluid Shifts (3 mmHg) and is NOT cardiac activity
- Absence of cardiac activity on ulrasound is not recommended as a prognostic indicator (AHA 2020)
- ROSC is ultimately achieved in 2.4% of patients without wall motion on Ultrasound
- Cardiac standstill has variable inter-rater reliability
- Compression quality
- Consider using Ultrasound over the femoral artery to follow circulation, compression quality
- References
- Swaminathan and Avila in Swadron (2021) EM:Rap 21(12): 5-8
- Swaminathan, Andrus and Mallon in Herbert (2018) EM:Rap 18(1): 8-9
- Orman and Reed in Herbert (2018) EM:Rap 18(3): 3-4
- Huis (2017) Resuscitation 119:95-8 +PMID:28754527
VIII. Management: Empiric Therapies
- Six empiric therapies to consider in Cardiac Arrest
- Mnemonic: "Never Carry Bling Through Gloomy Antwerp"
- Needle
- Calcium
- Calcium Chloride stabilizes Myocardium (e.g. Hyperkalemia)
- Blood (or fluid Resuscitation)
- NS or LR bolus (Hypovolemic Shock)
- Thrombolytics (e.g. tPA 50 mg)
- Massive Pulmonary Embolism
- Glucose
- Antidote
- See Toxin Antidote
- References
- Strayer in Herbert (2015) EM:Rap 15(8): 4-5
