HANDLING

SUDDEN CARDIAC ARREST

DR. D. B. PAHLAJANI
Consultant Cardiologist & Chief of Cardiac Catherization
Laboratory, Breach Candy Hospital
Sudden Cardiac Arrest (SCA)
Statistics

Ever t!" #inutes s"#e"ne su$ers a sudden

cardiac
arrest (SCA).
%a&"r 'i((er
!"r(d!ide

)ver *+,-,,, deat.s a ear

in t.e U.S. a("ne/.

)n( + 0 1, 2 "3 its victi#s

survive.
* American Heart Association 2002 Heart & Stroke statistical Update, Dallas, Texas : AHA 2000.
He died so suddenl and !e
didn"t e#en kno! $e $ad $eart
disease%
Sudden Cardiac Arrest (SCA)
Source : American Heart Association 2002 Heart & Stroke statistical Update, Dallas, Texas : AHA 2000.
Sudden Cardiac Arrest (SCA)
Incidence "3 SCA 4s )t.er %ain causes "3
deat.
Public Access Defibrillation World-Wide
Time to First Effective Shock
Sudden Cardiac Arrest (SCA)
225500,,000000
220000,,000000
115500,,000000
110000,, 000000
5500,,000000
00
119999 99 CCaa uusseess ooff DDeeaa tthh
Source: American Heart Associ ation. 2002 Heart and Stroke Statistical Update.
Dallas, Tex.: American Heart Association& 200'.
AIDS
Breast
Cancer *
Stroke SCA Lun
Cancer *

Heart Attac' (%"cardia( in3arcti"n) "ccurs

!.en t.e c"r"nar arter 5ec"#es 5("c'ed
and t.e 5(""d su66( t" .eart #usc(e is
interru6ted.

I3 t.e 5("c'a7e is n"t reversed in a #atter

"3 ."urs- 6er#anent da#a7e "ccurs.
Sudden Cardiac Arrest vs Heart Attac'

Sudden Cardiac Arrest "ccurs !.en t.e

.eart
starts 5eatin7 c.a"tica(( and is una5(e t"
6u#6 5(""d t" t.e 5"d (n" 6u(se "r
5reat.in7).

It is t.e resu(t "3 an e(ectrica( #a(3uncti"n

"3
t.e .eart.

Sudden Cardiac Arrest vs Heart Attac'

T.e .eart #usc(e

c"ntracts
in res6"nse t" e(ectrica(
sti#u(us 7enerated 5
t.e
.eart8s 6ace#a'er Ce((s
!it. t.e resu(t "3 a
6u(se-
5(""d 6ressure- 5reat.in7

9 "t.er si7ns "3
circu(ati"n.
Cardiac E(ectrica( C"nducti"n
Sinoatrial Node
N"r#a( Sinus R.t.#
4entricu(ar Tac.cardia
Sudden Cardiac Arrest (SCA)
4entricu(ar
:i5ri((ati"n
Causes !

Coronar" arter" disease

Acute coronar" s"ndro#es

$%ectrocution&

Dru to'icit" and sensiti(it"

As)h"'ia

Dro*nin

B%unt force trau#a to the chest&

Sudden Cardiac Arrest (SCA)

1+, Sudden Cardiac Deat.s 6er 1,,-,,, 6ers"ns

annua(( in industria(ised !"r(d.

;,2 "3 SCDs "ccur in 6e"6(e !it. n" 6ri"r .ist"r

"3
.eart disease.

SCD acc"unts 3"r #"re t.an +,2 "3 cardiac

#"rta(it.

Aut"s6ies revea(ed <,2 victi#s .ave CAD.

A7e a5"ve ;, rs.

Incidence "3 Sudden Cardiac Deat. (SCD)

Pri"r E6is"de "3 4.TACH

L"! L4E:.

Previ"us %"cardia( In3arcti"n.

C"r"nar Arter Disease

:a#i( Hist"r "3 SCD.

Cardi"#"6at.

C"n7estive Heart :ai(ure

L"n7 =T Sndr"#e.

Ri7.t 4entricu(ar Ds6(asia.

Ris' :act"rs "3 Sudden Cardiac Deat.
(SCD)
Treat#ent
Chain of Survival

$ar%" access&

$ar%" C+,&

$ar%" defi-ri%%ation&

$ar%" ad(anced %ife su))ort&

Sudden Cardiac Arrest (SCA)
Chain of Survival :irst (in' 0 Ear(
access
Ca(( 3"r He(6 >
Patient eva(uati"n

Deter#ine i3 c"nsci"us "r n"t- 5

6(acin7
"ne .and "n 6atient8s 3"re.ead and
s.a'in7 s."u(ders 7ent( !it.
an"t.er
.and.

In case "3 SCA 6atient !i(( n"t

res6"nd.
Sudden Cardiac Arrest (SCA)
Chain of Survival Sec"nd (in' 0 Ear(
CPR
Ste6s 6recedin7 Cardi"6u(#"nar Resuscitati"n
(CPR)

Deter#ine A-B-C "3 Basic Cardiac Li3e Su66"rt

(BCLS).
/ A 3"r Air!a.
/ B 3"r Breat.in7.
/ C 3"r Circu(ati"n.
Sudden Cardiac Arrest (SCA)

Air*a"
* Head tilt
* Finger
sweep.
* Jaw Thrust.
Sudden Cardiac Arrest (SCA)
Chain of Survival Sec"nd (in' 0 Ear(
CPR

Breathin
* Look Down the line of chest
to
to see it rise and fall.
* Listen at mouth and nose for
reathing sounds.
* Feel for e!pired air at
patients
mouth and nose.
Chain of Survival Sec"nd (in' 0 Ear(
CPR
Sudden Cardiac Arrest (SCA)

Circu(ati"n
* Feel " carotids
Chain of Survival Sec"nd (in' 0 Ear(
CPR
Sudden Cardiac Arrest (SCA)
)nce SCA is c"n?r#ed @@@@

Patient s."u(d 5e 6(aced "n .ard sur3ace.

Start CPR.

Give * eA6ired 5reat.s- 3"(("!ed 5 1+

c"#6ressi"ns.

C"ntinue *B1+ cc(es 3"r CPR 5"t. 3"r 1C 9 * C

rescuers

C"#6ressi"n rate C1,, 6er #inute

Chain of Survival Sec"nd (in' 0 Ear(
CPR
Sudden Cardiac Arrest (SCA)
%"ut. t" #"ut.
venti(ati"n

#emo$e an% o$ious ostruction.

&pen airwa%.

'inch $ictims nose.

(i$e mouth to mouth $entilation.

#epeat reaths.
Chain of Survival Sec"nd (in' 0 Ear(
CPR
Sudden Cardiac Arrest (SCA)
Cardiac c"#6ressi"ns

Locate correct chest compression site)

* " +ngers ao$e !iphoid.

'lace heel of other hand on the lower

end
of reast one.

Fingers o, the chest wall.

-ontinue till ./D is a$ailale.

Chain of Survival Sec"nd (in' 0 Ear(
CPR
Sudden Cardiac Arrest (SCA)
Chain of Survival Sec"nd (in' 0 Ear(
CPR
Sudden Cardiac Arrest (SCA)
Chain of Survival T.ird (in' 0 Ear(
De?5ri((ati"n

CPR saves ti#e

T.e #"st c"##"n cause "3 SCA is 4:- a (et.a(

r.t.#

T.e "n( e$ective treat#ent is de?5ri((ati"n

Sudden Cardiac Arrest (SCA)
Chain of Survival T.ird (in' 0 Ear(
De?5ri((ati"n

&$er 01 %ears ago) .H. e!panded its earl% de+rillation standard of care
to include
./Ds for in"hospital +rst responders 203314.

#esuscitation committees often 5inappropriatel%6 emphasi7e the arri$al of

core team
rather than the deli$er% of the +rst shock.

Treatment goal de+rillation within 8 min. an%where in the hospital.

AHADERC Standards 9 Guide(ines
./ Defi-ri%%ation 0S,
De?5ri((ati"n E(ectrica( Current St"6s 4:
Sudden Cardiac Arrest (SCA)
Chain of Survival T.ird (in' 0 Ear(
De?5ri((ati"n
Defi-ri%%ation $%ectrode +%ace#ent

Anteri"r 0 (atera(
6(ace#ent
Sudden Cardiac Arrest (SCA)
Chain of Survival T.ird (in' 0 Ear(
De?5ri((ati"n
Guidelines !!!

For communities 9
8": minutes) preferal% less than 8
minutes.

For hospitals 9
less than 8 minutes.
T.e I#6"rtance "3 TI%E B
Sudden Cardiac Arrest (SCA)
"i#e is the ene#y $
0 ' 2 ( ) * + , - .
1
Success
Time 2minutes4
Resuscitati"n Success vs.
Ti#e
Success rates decrease
23101 each #inute
Sudden Cardiac Arrest (SCA)
Chain of Survival T.ird (in' 0 Ear(
De?5ri((ati"n

Sur$i$al rates plunge ; 01 <

e$er% minute de+rillation is
dela%ed.

=uick action % +rst responder on

scene can sa$e a life.
S"(uti"n B Pu5(ic Access
De?5ri((ati"n

#ecogni7e S-. 20 to * mins4

Locate ./D > deli$er shock 2* mins4.

1 4itnessed ./ +atients Sur(i(in to 5os)ita% Dischare

691
21
261
01
101
201
701
601
501
801
201
901
,ecei(in shock :7
#in& after co%%a)se
(28 ; 75)
,ecei(in shock <7
#in& after co%%a)se
(22 ; 55)
0ationa% a(erae
Sudden Cardiac Arrest (SCA)
Chain of Survival T.ird (in' 0 Ear(
De?5ri((ati"n
Sa3et :irst

.ttach ./D onl% to someone not

reathing and without a pulse or
signs
of circulation.

?ake sure no one is touching the

$ictim.

@e sure the electrodes are +rml%

adhered to $ictims chest.

?o$e o!%gen awa% from the rescue

e,ort efore de+rillation.
Sudden Cardiac Arrest (SCA)
Chain of Survival T.ird (in' 0 Ear(
De?5ri((ati"n

T"da8s AEDs are #"re 6ractica( 3"r use in t.e !"r'

6(ace
and 6u5(ic 6(aces
* Aoice prompts are more intuiti$e.
* ./Ds do self tests and are $irtuall% maintenance free.
Sudden Cardiac Arrest (SCA)
Chain of Survival T.ird (in' 0 Ear(
De?5ri((ati"n
A$Ds are 4$LL S=I>$D for =S$ -" 0?03>,ADI>I?0AL ,$S+?0D$,S
E." is Usin7 AEDs T"da F

/li0$t Attendants

/ire1i0$ters.

2aramedics

3orporate 4mer0enc 5esponse Teams

Securit 611icers

/actories7 8ndustries

S$oppin0 9alls

3orporate 611ices

2olice 1orce

:ol1 2ros

Healt$ clu; emploees

Automated external de1i;rillators
<A4Ds= are sa1e 1or trained la
rescuers to use, to treat sudden
cardiac arrest. T$e de#ices
anal>e a #ictim"s $eart r$t$m
and onl allo! an electric s$ock
to ;e deli#ered !$en necessar.
read moreB
DID YOU KNOW?
S"urce B AHA !e5site
Sudden Cardiac Arrest (SCA)
Chain of Survival T.ird (in' 0 Ear(
De?5ri((ati"n
Chain of Survival T.ird (in' 0 Ear(
De?5ri((ati"n

Se#i Aut"#atic B .nal%ses patientCs rh%thm and

ad$ises if
rh%thm needs a shock. &perator has to press
5shock6 utton
to deli$er the shock.

:u(( Aut"#atic B .nal%ses patientCs rh%thm and

deli$ers
shock if reDuired all % itself.
T6es "3 AEDs
Sudden Cardiac Arrest (SCA)
Chain of Survival T.ird (in' 0 Ear(
De?5ri((ati"n

Se#i Aut"#atic EAterna(

De?5ri((at"r B
TGPES ): AEDs
Si#6(e * Butt"n
)6erati"n

)ND)::

%&uto &nalyze'

SH)CH
Sudden Cardiac Arrest (SCA)
Si#6(e 1 Butt"n )6erati"n

)ND)::

%&uto &nalyze & &uto Shoc( if re)uired'

Chain of Survival T.ird (in' 0 Ear(
De?5ri((ati"n

:u(( Aut"#atic EAterna( De?5ri((at"r B

TGPES ): AEDs
Sudden Cardiac Arrest (SCA)
Chain of Survival :"urt. (in' 0 Ear(
ACLS

:"r advanced Cardiac Li3e su66"rt (ACLS) s.i3t t.e

6atient
t" t.e nearest ."s6ita(.

Treat victi# !it. #edicine and advanced

t.era6ies.
Sudden Cardiac Arrest (SCA)
%ESSAGE :)R ALL ): US
Sudden Cardiac Arrest (SCA)
T.e :UTURE !i(( see severe c"#6etiti"n due
t" !.ic. tensi"ns are 7"in7 t" #"unt.
Ee #ust care 3"r HIGH PR):ILE INDI4IDUALS.
%ust 6r"vide LI:E SA4ING SUPP)RT t"
.and(e suc. E4ENTUALITIES.
Thank %ou E
Hand(in7 Sudden Cardiac Arrest
(SCA)