Cardiorespiratory arrest

The contents of this chapter are firmly linked to the teaching and algorithms of the Resuscitation Council (UK) (2005) and the European Resuscitation Council (2005). The current guidelines are evidence-based and were published after representatives from the world's major resuscitation organisations met and reviewed scientific evidence and audit data accrued since the year 2000. From this meeting the 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (International Liaison Committee on Resuscitation 2005) were published. This is the evidence on which the current guidelines are based.

Causes

A person suffers a cardiorespiratory arrest either because of a primary cardiac problem or secondary to non-cardiac causes. The majority of cardiac arrests occurring outside hospital are from ventricular fibrillation (VF) in adults due to myocardial ischaemia arising from pre-existing ischaemic heart disease (IHD). Other cardiac conditions which may lead to cardiorespiratory arrest include valvular heart disease, cardiomyopathy, myocarditis, endocarditis and conduction defects, e.g. Wolff–Parkinson–White syndrome or prolonged atrioventricular (AV) block.

An important secondary cause of cardiorespiratory arrest is uncorrected hypoxia resulting from airway obstruction. Hypoxia leads to myocardial failure, which is compounded by the resulting hypercarbia and acidosis. A bradycardia will develop, and this will be followed by an asystolic cardiac arrest unless the airway obstruction is cleared. Some causes of airway obstruction are listed in Figure RS1.