Page 677 - ACCCN's Critical Care Nursing

24 Resuscitation

Trudy Dwyer
Jennifer Dennett

management, rhythm recognition, administration of
Learning objectives medications and post resuscitation care. Resuscitation
involves many moral and ethical issues, such as family
After reading this chapter, you should be able to: presence during resuscitation, deciding when to cease or
l identify the clinical assessment used to identify sudden initiate resuscitation, and near-death experiences.
cardiac arrest (SCA).
l outline the role of the chain of survival in the management BACKGROUND
of SCA.
l outline the management of common arrhythmias Coronary heart disease (CHD) is the leading cause of
associated with SCA. death in most industrialised countries, with over half of
1-3
l describe the use of advanced airway adjuncts and these being due to sudden cardiac arrest (SCA). Despite
advances in CHD management, survival outcome figures
indications for use in SCA. from SCA remain poor. Survival after SCA is dependent
4-6
l discuss indications, actions and routes of administration of on the presenting rhythm, early defibrillation, effective
medications used in advanced life support. cardiopulmonary resuscitation and advanced life sup-
l describe the appropriate care of persons experiencing SCA port. Because the presenting rhythm with the majority
6
including specific circumstances such as the pregnant of witnessed SCAs is ventricular fibrillation, bystander
woman, electrical injuries and drowning. cardiopulmonary resuscitation and early defibrillation
l discuss current research in resuscitation. are the major interventions influencing outcome after
SCA. 2,6-7 It is possible that the number of ventricular
fibrillation/ventricular tachycardia (VF/VT) arrests is actu-
ally higher than reported, as often by the time the cardiac
Key words arrest team arrives the patient’s rhythm has deteriorated
to asystole. 8
resuscitation
cardiopulmonary resuscitation INCIDENCE/AETIOLOGY OF CARDIAC ARRESTS
advanced life support The prevalence of CHD varies worldwide, thus estimates
of the incidence of SCA are difficult to obtain. In Austra-
lia, CHD is the leading cause of disease burden (9%) and
INTRODUCTION accounts for 16.5% of all deaths. 9,10 There are many
factors that contribute to cardiac arrest. In adults, the
The continuum of critical illness for an individual can most common cause of cardiac arrest is a primary cardiac
11
span the period before and beyond hospital admission. event, with coronary artery disease accounting for up to
Resuscitation is often required outside the critical care 90% of all victims. 12,13 CHD is the most likely cause of
environment, and the ‘cardiac arrest’ team has evolved to death in those over 35 years of age, compared to non-
use a more proactive, early-intervention approach, utilis- cardiac causes such as drowning, acute airway obstruction
ing a range of systems and instruments to detect deterio- or trauma for people less than 35 years of age. 13
ration in patients’ clinical status (see Chapter 3). It is well While causes of cardiac arrest are numerous, most often
recognised that improved outcomes from cardiac arrest it is associated with ventricular fibrillation triggered by an
are dependent on early recognition and initiation of the acutely ischaemic or infarcted myocardium or primary
‘chain of survival’. This chapter introduces the resuscita- electrical disturbance. Causes of cardiac arrest may be
3
tion systems and processes in both the prehospital and separated into two categories, primary and secondary, as
the in-hospital settings. The chain of survival provides a displayed in Table 24.1.
framework for the management of the person experienc-
ing cardiac arrest and resuscitation in specific circum- Acute myocardial infarction (AMI) is the most common
stances. The chapter expands on the final link in the precursor to cardiac arrest. In victims of trauma, drug
654 chain, advanced life support, to outline advanced airway overdose and drowning, the predominant cause of cardiac