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Course: Medical Surgical Nursing

Topic: Cardiac Arrest

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Module Goals

Learners will be able to

Describe the clinical manifestations of cardiac arrest.
Discuss the assessment and diagnostic findings of cardiac arrest.
Discuss the complications of cardiac arrest.
Describe the medical management of cardiac arrest.
Discuss the nursing management of cardiac arrest.

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Cardiac Arrest: Definition

Cardiac arrest is the abrupt loss of heart function

Heart’s electrical system malfunctions
Person may or may not have diagnosis of heart disease

Cardiac arrest is not the same as myocardial infarction (MI)

Cardiac arrest may be caused by arrhythmias

A common arrhythmia associated with cardiac arrest is ventricular fibrillation

Cardiac arrest is a common cause of death

Causes approx 300,000 to 450,000 deaths in the USA per year

AHA, 2021

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Cardiac Arrest: Definition (Continued)

Cardiac arrest can be fatal unless action is taken immediately

Cardiac arrest can be reversed if Cardiopulmonary Resuscitation (CPR) is performed
A defibrillator may be used to shock the heart and restore normal sinus rhythm

AHA, 2021

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CPR: Cardiopulmonary Resuscitation

NOTE: Start compressions within 10 seconds of recognition of cardiac arrest.

Hand placement for adults: 2 hands on lower half of breastbone.
Compress at a rate of 100-120 compressions per minute with a depth of at least 2 inches (5 cm) for adults.
Allow complete chest recoil after each compression.
Give effective breaths that make the chest rise.

Goyal et al., 2023

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Clinical Manifestations of Cardiac Arrest

The clinical manifestations of cardiac arrest include:

Sudden collapse and loss of consciousness
Absence of pulses
Not breathing
Cyanotic
Unresponsiveness: lack of response to shouting or shaking

NIH, May 2022a

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Quiz: Cardiac Arrest

Please list the five clinical manifestations of cardiac arrest.

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Medical Management of Cardiac Arrest

Medical management of the patient with cardiac arrest include

Initial Evaluation plus Basic Life Support
Beginning CPR
Providing patent airway
Defibrillation
Advanced Life Support
Endotracheal tube insertion
Intravenous line insertion
Post-resuscitation care
Starts with the return of spontaneous circulation
Oxygen administration

Sharabi & Singh, 2023

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Medical Management of Cardiac Arrest (Continued)

Medical Treatment focuses on prevention of organ damage, especially brain

Targeted Temperature Management (TTM)

Protects brain by lowering body temperature

Extracorporeal membrane oxygenation (ECMO)

Pumps oxygen through body through an artificial lung

Determination of any other needed treatments

Medicines
Surgical heart procedures such as bypass surgery or angioplasty

NIH, 2022b

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Targeted temperature management (TTM) is necessary for all patients who cannot follow commands after their heartbeat returns. TTM uses cooling blankets, cooling helmets, ice packs, or other methods.
Oxygen therapy can help get enough oxygen into the lungs for organ function.
Extracorporeal membrane oxygenation (ECMO) treatment pumps blood through an artificial lung to add oxygen and remove carbon dioxide before returning the blood to the body.
For the patient diagnosed with coronary heart disease, treatments may include medicines and surgical heart procedures such as bypass surgery and percutaneous coronary intervention (also known as coronary angioplasty), a procedure that may also include placing a stent.
These procedures help restore blood flow through narrowed or blocked coronary arteries.

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Nursing Management of Cardiac Arrest

Check vital signs/pulse/respirations
Begin CPR
Have resuscitation cart at bedside
Insert IV cannula if needed
Document medication administration and treatment
Apply defibrillator pads

Patel et al., 2023

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Cardiac Arrest: Medications

Vasopressors

*Epinephrine-drug of choice

Antiarrhythmics

Amiodarone

Atropine

Sharabi & Singh, 2023

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Complications of Cardiac Arrest

Neurological injury due to hypoxia
Organ systems may suffer ischemic injury
Rib injury from compressions
Changes in quality of life
Changes in psychological wellbeing

Goyal et al., 2023

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Patient Education After Cardiac Arrest

Follow-up appointments as directed by provider
Take all medications as prescribed
Warning signs of myocardial infarction
Heart-healthy eating
Exercise as directed by provider
Mental health: tips to manage stress

NIH, 2022c

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Red Flags

The procedure to follow in a cardiac arrest situation:

Check for pulse and responsiveness
Begin CPR Immediately
Simultaneously, initiate code/call for help

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures, talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures, family members play a large role in healthcare decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting and following treatment recommendations.

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health-seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be okay in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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References

Agency for Healthcare Research and Quality (AHRQ). (2020). Home. https://www.ahrq.gov/

American Heart Association (AHA). (2021). What is Cardiac Arrest? https://www.heart.org/en/health-topics/cardiac-arrest/about-cardiac-arrest

Goyal, A., Sciammarella, J. C., Cusick, A. S., & Patel, P. H. (2023). Cardiopulmonary Resuscitation. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470402/

National Heart, Lung, and Blood Institute (NHLBI). (2022a). Symptoms. National Institute of Health. https://www.nhlbi.nih.gov/health/cardiac-arrest/symptoms

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References

National Heart, Lung, and Blood Institute (NHLBI). (2022b). Treatment. National Institute of Health https://www.nhlbi.nih.gov/health/cardiac-arrest/treatment

National Heart, Lung, and Blood Institute (NHLBI). (2022c). Cardiac Arrest: Life after. National Institute of Health. https://www.nhlbi.nih.gov/node/93988

Patel, K., Hipskind, J. E., & Akers, S. W. (2023). Cardiac Arrest (Nursing). StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568720/

Sharabi, A. F., & Singh, A. (2023). Cardiopulmonary Arrest in Adults. StatPearls Publishing. Cardiopulmonary Arrest In Adults - StatPearls - NCBI Bookshelf

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