CAUSES AND PREVENTION

OF CARDIORESPIRATORY
ARREST

© Resuscitation Council (UK) ERC

 Objectives
To understand:
• The causes of cardiorespiratory arrest
• How to identify patients ‘at risk’
• The importance of preventing a cardiorespiratory arrest
• The role of a Medical Emergency Team
• The initial management of patients ‘at risk' of a
cardiorespiratory arrest

ERC
Outcome from in-hospital cardiac arrest

VF / VT Non VF / VT
939
1000 68.6%

800
429
600
31.4%
400
42.2%
200 6.2%
0
ed

d
d

d
SC

SC

e
te

te
rg

rg
es

es
O

O
a

a
R

R
rr

rr
ch

ch
A

A
is

is
D

D
Gwinnutt C et al Resuscitation 2000;47: 125-135
ERC
Care of the critically ill patient
is frequently sub-optimal
Confidential enquiry into ITU admissions
•
40% admissions avoidable
•
37% admissions occurred late
•

Lack of attention to
Airway, Breathing and Circulation
McQuillan P et al BMJ 1998;316:1853-1858

ERC
Sub-optimal care leads to
cardiac arrest and poor
outcome
30-70% patients who suffer a cardiorespiratory
arrest in hospital have signs of physiological
deterioration prior to the arrest

ERC
ABCDE approach

A… airway
B… breathing
C… circulation
D… disability
E… exposure

ERC
Causes of cardiorespiratory arrest
1. Airway obstruction
CNS depression
•
Blood, vomit, foreign body
•
Trauma
•
Infection, inflammation
•
Laryngospasm
•

ERC
 Airway obstruction
Symptoms and signs Actions
• Difficulty breathing, distressed, • Oxygen
choking • Suction, positioning
• Shortness of breath • BLS manoeuvres
• Stridor, wheeze, gurgling • Advanced airway
See-saw respiratory pattern intervention
•

ERC
Causes of cardiorespiratory arrest
2. Breathing inadequacy
Pulmonary disorders
• infection
– collapse
– pneumothorax
– asthma
–
Decreased respiratory drive
• CNS depression
–
Decreased respiratory effort
• muscle weakness
– restrictive chest defect
–

ERC
 Breathing inadequacy
Symptoms and signs Action
• Short of breath, anxious, • Oxygen
irritable
• Ventilatory support
• Decrease in conscious level
Tachypnoea • Treat underlying cause
•
where possible
• Cyanosis

ERC
Causes of cardiorespiratory arrest
3. Cardiac abnormalities
Primary Secondary
• Ischaemia • Asphyxia
• Myocardial infarction • Hypoxaemia
• Hypertensive heart disease Blood loss
•
• Valve disease
• Septic shock
• Drugs
• Electrolyte abnormalities

ERC
Circulatory / cardiac inadequacy
Symptoms and signs Action
Oxygen
• Tachycardia •
•
Fluids
Inotropes
• Bradycardia •

• Hypotension
• Poor perfusion (CRT)
Poor cerebration
• Poor urine output

CRT = capillary refill time

ERC
Disability / CNS abnormality

Primary Secondary
• Trauma • Hypoxia
• CVA • Metabolic
• Infection
• Poisons

ERC
 AVPU

• A - alert
• V - responds to voice
• P - responds to pain
• U - unresponsive

ERC
Disability / CNS abnormality

Any CNS depression can lead to

severe airway, breathing and
circulatory problems

ERC
 Recognition of patients ‘at risk’
• History, examination, investigations
• Clinical indicators of deterioration before in-hospital cardiorespiratory
arrest in 80%
– tachypnoea
– tachycardia
– hypotension
– reduced conscious level

ERC
Medical Emergency Team (MET)
Example Calling Criteria
• Airway threatened • Neurology
• Breathing
– sudden fall in
– respiratory arrest
– RR < 5 or RR >36
GCS > 2
• Circulation • Any other
– cardiac arrest concerns
– PR < 40 or PR >140
– systolic BP < 90 RR = respiratory rate
PR = pulse rate

ERC
 Medical Emergency Team

• Call team early

• Empowers nursing staff and
doctors to call for senior help
• DNAR status may be clarified
• Improved survival

ERC
Any Questions ?

ERC
 Summary
• Airway, breathing, circulatory or
neurological problems can cause
cardiorespiratory arrest
• Patients often have warning symptoms
and signs
• Earlier recognition of patients ‘at risk’
may prevent cardiorespiratory arrest

ERC