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Cardiac Arrest, Hypothermia and Resuscitation Science

Lecture 1: Introduction to resuscitation science

Benjamin S. Abella, MD MPhil

Clinical Research Director

Center for Resuscitation Science

Department of Emergency Medicine

University of Pennsylvania

Coursera

July 2012

An introductory course for the educated lay public and health care providers

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Dr. Abella: conflicts of interest disclosures

Employment: University of Pennsylvania

Research funding: National Institutes of HealthPhilips HealthcareMedtronic Foundation

Consulting: Velomedix, Inc.HeartSine Technologies

Volunteer: American Heart Association

No equity or intellectual property related to resuscitation science

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What is cardiac arrest?

Electrical recordingof the heart rhythm:

Normal rhythm:

heart is moving blood

(functional cardiac output)

Cardiac arrest rhythm:

chaotic rhythm means no blood flow

(no functional cardiac output)

In cardiac arrest, the blood pressure quickly falls to zero

Blood flow to the organs stops, abruptly and completely

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What is cardiac arrest?

Without any blood flow to the lungs or brain,

the victim of cardiac arrest is technicallydead and appears lifeless

(For brief minutes, may have gasping orseizure activity)

The immediate actions required to restoreblood flow:

1. Cardiopulmonary resuscitation (CPR)2. Electrical defibrillation

Both of these can be done by the lay public

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History of cardiopulmonary resuscitation (CPR)

Something like mouth-to-mouth in the Bible:Kings Chapter 2, Elijah treated a collapsed

childhe put his mouth upon [the childs]mouth and the flesh of the child waxed warm

As early as the 1500s, notion of using a bellows

to revive victims of drowning and smokeinhalationfell out of practice in the 1800s

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Modern history of CPR and defibrillation

Drs. Knickerbocker, Kouwenhoven, and JudeJohns Hopkins, 1950sstudied defibrillationand chest compressions in the laboratory

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1961

A. Peter Safar, 1950smodernmouth-to-mouth

B. Early symposium on CPR

A B

Modern history of CPRventilations and putting it together

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Resuscitation and CPR in 2012

Consensus resuscitation guidelinesupdated every five years,published in the US by the American Heart Association

Worldwide training of CPR

Certification courses:BLS Basic Life SupportACLS Advanced Cardiovascular

Life Support

Training programs for using defibrillatorsVideo-based CPR trainingHands-only CPR (without mouth-to-mouth)

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Resuscitation and CPR in 2012

New directions in CPR:

Hands-only CPRevidencesuggests mouth-to-mouth maynot be required, especially forbystander response

New for 2010 guidelines:

Airway-Breathing-Circulationis now

Circulation-Airway-Breathing

CA B

. more on this in lecture 2

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Cardiac arrest and heart attack are not the same thing

A heart attack(myocardial infarction orMI)is from blockages in the coronary arteries,blood vessels that feed the heart

These blockages grow over years, relatedto genetic factors, smoking, hypertension,

and other risk factors

Normal

coronary

artery

Diseased coronary arteries

(coronary plaque)

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Cardiac arrest and heart attack are not the same thing

In a heart attack, a complete blockageleads to death of a portion of heart muscle

In most cases of heart attack, the victim livesand does not need CPR or defibrillation

Treatments for heart attack include:

aspirinangioplastycoronary stent placementanticoagulant medications

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Cardiac arrest compared to heart attack

Pathophysiology

Symptoms

Cardiac activity

Mortality

Treatment

Cardiac arrest Heart attack

Cardiac function Portion of heart muscleSuddenly stops starved of blood flow

Sudden collapse chest pain, nausea,shortness of breath

NO YES

Very high mortality low mortality

CPR, defibrillation aspirin, angioplasty