HANDLING

SUDDEN CARDIAC ARREST

DR. D. B. PAHLAJANIConsultant Cardiologist & Chief of Cardiac Catherization

Laboratory, Breach Candy Hospital

Sudden Cardiac Arrest (SCA)

Statistics

Every two minutes someone suffers a sudden cardiac arrest (SCA).

Major killer worldwide Over 250,000 deaths a year

in the U.S. alone*.

Only 5 – 10 % of its victims survive.

* American Heart Association 2002 Heart & Stroke statistical Update, Dallas, Texas : AHA 2000.

“He died so suddenly and we didn’t even know he had heart disease”

Sudden Cardiac Arrest (SCA)

Source : American Heart Association 2002 Heart & Stroke statistical Update, Dallas, Texas : AHA 2000.

Sudden Cardiac Arrest (SCA)

Incidence of SCA Vs Other Main causes of death Public Access Defibrillation World-Wide

Time to First Effective Shock

Sudden Cardiac Arrest (SCA)

225500 ,,0000 00

220000 ,,0000 00

115500 ,,0000 00

110000,,0000 00

5500 ,,00 0000

00

119999 99 CC aa uusseess ooff DD eeaa tthh

Source: American Heart Association. 2002 Heart and Stroke Statistical Update .Dallas, Tex.: American Heart Association; 2001.

AIDS Breast Cancer *

Stroke SCALung Cancer *

Heart Attack (Myocardial infarction) occurs

when the coronary artery becomes blocked

and the blood supply to heart muscle is

interrupted.

If the blockage is not reversed in a matter

of hours, permanent damage occurs.

Sudden Cardiac Arrest vs Heart Attack

Sudden Cardiac Arrest occurs when the heart starts beating chaotically and is unable to pump blood to the body (no pulse or breathing).

It is the result of an electrical malfunction of the heart.

Sudden Cardiac Arrest vs Heart Attack

The heart muscle contracts in response to electrical stimulus generated by the heart’s pacemaker Cells with the result of a pulse, blood pressure, breathing & other signs of circulation.

Cardiac Electrical Conduction

Sinoatrial Node

Normal Sinus Rhythm

Ventricular Tachycardia

Sudden Cardiac Arrest (SCA)

Ventricular FibrillationCauses : Coronary artery disease

Acute coronary syndromes

Electrocution.

Drug toxicity and sensitivity

Asphyxia

Drowning

Blunt force trauma to the chest.

Sudden Cardiac Arrest (SCA)

150 Sudden Cardiac Deaths per 100,000 persons annually in industrialised world.

40% of SCDs occur in people with no prior history of heart disease.

SCD accounts for more than 50% of cardiac mortality.

Autospies revealed 90% victims have CAD.

Age above 40 yrs.

Incidence of Sudden Cardiac Death (SCD)

Prior Episode of V.TACH

Low LVEF.

Previous Myocardial Infarction.

Coronary Artery Disease

Family History of SCD.

Cardiomyopathy

Congestive Heart Failure

Long QT Syndrome.

Right Ventricular Dysplasia.

Risk Factors of Sudden Cardiac Death (SCD)

Treatment

“Chain of Survival” Early access.

Early CPR.

Early defibrillation.

Early advanced life support.

Sudden Cardiac Arrest (SCA)

“Chain of Survival” First link – Early access

Call for Help !

Patient evaluation Determine if conscious or not, by placing one hand on patient’s forehead and shaking shoulders gently with another hand.

In case of SCA patient will not respond.

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Second link – Early CPR

Steps preceding Cardiopulmonary Resuscitation (CPR)

Determine A,B,C of Basic Cardiac Life Support (BCLS).

* A for Airway.

* B for Breathing.

* C for Circulation.

Sudden Cardiac Arrest (SCA)

Airway

* Head tilt

* Finger sweep.

* Jaw Thrust.

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Second link – Early CPR

Breathing

* Look – Down the line of chest to to see it rise and fall.

* Listen – at mouth and nose for breathing sounds.

* Feel – for expired air at patients mouth and nose.

“Chain of Survival” Second link – Early CPR

Sudden Cardiac Arrest (SCA)

Circulation

* Feel - carotids

“Chain of Survival” Second link – Early CPR

Sudden Cardiac Arrest (SCA)

Once SCA is confirmed …………

Patient should be placed on hard surface.

Start CPR.

Give 2 expired breaths, followed by 15 compressions.

Continue 2:15 cycles for CPR both for 1- & 2 - rescuers

Compression rate -100 per minute

“Chain of Survival” Second link – Early CPR

Sudden Cardiac Arrest (SCA)

Mouth to mouth ventilation

Remove any obvious obstruction.

Open airway.

Pinch victims nose.

Give mouth to mouth ventilation.

Repeat breaths.

“Chain of Survival” Second link – Early CPR

Sudden Cardiac Arrest (SCA)

Cardiac compressions

Locate correct chest compression site,

2 - fingers above xiphoid.

Place heel of other hand on the lower end

of breast bone.

Fingers off the chest wall.

Continue till AED is available.

“Chain of Survival” Second link – Early CPR

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Second link – Early CPR

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Third link – Early Defibrillation

CPR saves time

The most common cause of SCA is VF, a lethal rhythm

The only effective treatment is defibrillation

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Third link – Early Defibrillation

Over 10 years ago, AHA expanded its early defibrillation standard of care to include

AEDs for in-hospital first responders (1990).

Resuscitation committees often “inappropriately” emphasize the arrival of core team

rather than the delivery of the first shock.

Treatment goal – defibrillation within 3 min. anywhere in the hospital.

AHA/ERC Standards & Guidelines

VF Defibrillation NSR

Defibrillation Electrical Current Stops VF

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Third link – Early Defibrillation

Defibrillation Electrode Placement

Anterior – lateral placement

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Third link – Early Defibrillation

Guidelines 2000

For communities :

3-5 minutes, preferably less than 3 minutes.

For hospitals :

less than 3 minutes.

The Importance of TIME :

Sudden Cardiac Arrest (SCA)

Time is the enemy :

0 1 2 3 4 5 6 7 8 9

% Success

Time (minutes)

Resuscitation Success vs. Time

Success rates decrease 7-10% each minute

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Third link – Early Defibrillation

Survival rates plunge 7 – 10 % every minute defibrillation is delayed.

Quick action by first responder on scene can save a life.

Solution : Public Access Defibrillation

Recognize SCA (1 to 2 mins)

Locate AED & deliver shock (2 mins).

% Witnessed VF Patients Surviving to Hospital Discharge

49%

7%

74%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Receiving shock <3min. after collapse

(26 / 35)

Receiving shock >3min. after collapse

(27 / 55)

National average

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Third link – Early Defibrillation

Safety First Attach AED only to someone not

breathing and without a pulse or signs

of circulation.

Make sure no one is touching the victim.

Be sure the electrodes are firmly adhered to victims chest.

Move oxygen away from the rescue effort before defibrillation.

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Third link – Early Defibrillation

Today’s AEDs are more practical for use in the work place and public places

* Voice prompts are more intuitive.

* AEDs do self tests and are virtually maintenance free.

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Third link – Early Defibrillation

AEDs are WELL SUITED for USE by NON-TRADITIONAL RESPONDERS

Who is Using AEDs Today ?

Flight Attendants Firefighters. Paramedics Corporate Emergency Response Teams Security Officers Factories/ Industries Shopping Malls Corporate Offices Police force Golf Pros Health club employees

Automated external defibrillators (AEDs) are safe for trained lay rescuers to use, to treat sudden cardiac arrest. The devices analyze a victim’s heart rhythm and only allow an electric shock to be delivered when necessary.

read more…

DID YOU KNOW?

Source : AHA website

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Third link – Early Defibrillation

“Chain of Survival” Third link – Early Defibrillation

Semi Automatic : Analyses patient’s rhythm and advises if

rhythm needs a shock. Operator has to press “shock” button

to deliver the shock.

Fully Automatic : Analyses patient’s rhythm and delivers

shock if required all by itself.

Types of AEDs

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Third link – Early Defibrillation

Semi Automatic External Defibrillator :

TYPES OF AEDs

Simple 2 Button Operation

ON/OFF

(Auto Analyze)

SHOCK

Sudden Cardiac Arrest (SCA)

Simple 1 Button Operation

ON/OFF

(Auto Analyze & Auto Shock if required)

“Chain of Survival” Third link – Early Defibrillation

Fully Automatic External Defibrillator :

TYPES OF AEDs

Sudden Cardiac Arrest (SCA)

“Chain of Survival” Fourth link – Early ACLS

For advanced Cardiac Life support (ACLS) shift the patient

to the nearest hospital.

Treat victim with medicine and advanced therapies.

Sudden Cardiac Arrest (SCA)

MESSAGE FOR ALL OF US

Sudden Cardiac Arrest (SCA)

The FUTURE will see severe competition due

to which tensions are going to mount.

We must care for HIGH PROFILE INDIVIDUALS.

Must provide LIFE SAVING SUPPORT to

handle such EVENTUALITIES.

Thank you !

Handling Sudden Cardiac Arrest (SCA)