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SUDDEN CARDIAC DEATH PREVENTION AND CARDIO-PULMONARY RESSUSSITATION (CPR)

SUDDEN CARDIAC DEATH PREVENTION AND CARDIO-PULMONARY RESSUSSITATION (CPR). Rasim ENAR; M.D Professor of Cardiology İstanbul University Cerrahpaşa Medical Faculty Department of Cardiology. SUDDEN CARDIAC DEATH (SCD). Definition: “Natural Death due to cardiac causes

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SUDDEN CARDIAC DEATH PREVENTION AND CARDIO-PULMONARY RESSUSSITATION (CPR)

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  1. SUDDEN CARDIAC DEATHPREVENTION AND CARDIO-PULMONARY RESSUSSITATION (CPR) Rasim ENAR; M.D Professor of Cardiology İstanbul University Cerrahpaşa Medical Faculty Department of Cardiology

  2. SUDDEN CARDIAC DEATH (SCD) Definition: “Natural Death due to cardiac causes (1) Loss of consciousness within one hour after start of the symptoms (2) Pre-existing heart disease may be present; but the cause or the timing of the death can not be predicted Keys of Definition : (a)Non-taumatic nature (b) Unexpected and sudden

  3. CARDIAC ARREST Definition: Sudden cessation of cardiac pump function Reversible with rapid and effective intervention; otherwise cardiac death is unevitable ►►►The common electrophysological mechanism which cause cardiac arrest as a cause of SCD: (1)- Ventricular Tachyarrhytmias; Ventricular Fibrillation, Ventricular Tachycardia (2)-Non-Tachyarrhytmic causes ; Other important causes of cardiac arrest; Pulseless electrical activity (Electromachanical Dissosiation); Asistoly; Bradiarrhythmias

  4. ECG:Sınus arrest No P waves.

  5. ECG: VF

  6. ECG: Polimorphic VT (Torsade de Pointes)

  7. ECG: Complete AV Block • Dissociate P an QRS waves.

  8. ETY-1: SCD- CARDIOVASCULAR DISEASES:. ►1-Coronary artery disease Acute coronary sydrome, Chronic ischemic heart disease ►2-Dilated cardiomyopathy *► “The above two cinical states is responsible for >90% of SCD events”. ►3- Other cardiomyopathies; (a) hipertrophic cardiomyopathy, (b) arrhythmogenic right ventricular cardiomyopathy ►4-Primary “electrical” disturbances. ►5-Mechanical cardiovascular diseases.

  9. ETY -2:►4- Primary “electrical” disturbances: (a)Long QT syndrome (b)Brugada syndrome (c) Cathecholaminergic polimorphic VT. (d)Wolf-Parkinson-White syndrome (WPW). (e) Sinus and AV node related conduction disturbances

  10. ETY-3 SCD -Mechanical Cardiyovascular Diseases; a-Aortic stenosis. b-Mitral valve prolapse c- Myocardial bridging d- Anolomous coronary artery origin --------------------------------------------------------------------ETY-4► SCD-Other Causes: (a) Myocarditis (b) Chest trauma (c) Drug overdose - Torsade de Pointes (d) Atheletes heart _ trained heart (e) SCD in normal heart (idiopathic VF).

  11. Prevention from SCD: ►Principal: Multi-factorial etiology and various treatment targets. -------------------------------------------------------- ►Primary prophlaxis:Prevention of fatal arrhythmias in patients without prior sustainead VT and high risk for SCD ►Secondary prophlaxis: Prevention of fatal arrhythmias in patients who exprerienced cardiac arrest and sustained ventricular tachyarrhytmias

  12. PrimaryProflaxis: 3 different proflactic treatment modalities: 1- Drugs without electrophysiologic effects 2- Drugs with electrophysiologic effects 3- ICD(Implantable Cardiac Defibrillator)

  13. 1- Drugs without electrophysiologic effects : Importance of the treatment: Both total mortality and SCD is reduced. ------------------------------------------------------------ 3 different class drugs: 1- ACE-I (angiootensin converting enzyme inhibitors), ARB (+?) 2- Aldosterone receptor blockers 3-Poli-unsaturated fatty acids (omega-3) +-Statins

  14. RESSUSİTATION. • Return of spontaneous circulation (ROS) can be achived only 15% of cardiac arrest cases, and only 50% of those could be discharged • As a result;There is only a 5-7% chance of survival in cardiac arrst victims. • Survival from cardiac arrest: (a) Etiolgy of cardiac arrest (VF>EM-Diss), (b) Pre- cardiac arrest status, (c) Unwitnessed cardiac arrest (d) Emergency CPR and availability of automated external defibrilator

  15. CHAIN OF SURVIVAL:(ABLS: Adult Basic Life Support)“Call 112,+Chest compression +Defibrilltor+ IV DrugTherapy”.

  16. Electrical meaning of Ressussitation: • VF is the most common cause of cardiac arrest • Spontaneous termination does not occur • VF more than 3-4 minutes causes irrversible organ damage. • Prevention of death secondary to cardiac arrest • Immediate, rapid Defibrillation (DFB). * Every minute delay with DFB reduces life expactancy by 7-10% according to direct CPR with chest compression or entubation

  17. External Defibrillator. • Devices with automated rhythm analysis and shock delivery features • External defibrilator (EDFB); should be used only in patients who are unresponsive, not breathing and without effective circulation

  18. DEFIBRILATOR(DFB): Manually operated; Paddeles and Monitore.

  19. Eksternal Defibrilator- Localization of Pedals

  20. Return of NSR (“arrow sign”) after DFB of VF

  21. CPR; Cardio-Pulmonary Ressussitation • If immediate DFB is not possible, then CPR should be started without delay. • Late-CPR and/or advanced cardiac life support (ACLS) should be discouraged. • Only 10-20% of out-of hospital VF cases survive and 50% of those will have neurological problems. • As a result:If cardiac arrest is not diagnosed within 4 minutes and CPR and DFB is not given within 8 minutes; ressussitation will be unsuccessful.

  22. How to do CPR ? • BLS (Basıc Life Support) Algorhthm: • --------------------------------------------------------------------------------------------- • 1- Check the responsiveness ; if unresponsive- start CPR: • 2-Open Airway; “Head tilt-jaw trust” • ►► 3- Check the breathing- not breathing; Start mouth-to-mouth breathing • 4- Give your breath ; - Give 1-1,5 seconds break for breathing and observe the patient after the first two full breaths • 5- Assess circulation;- Check pulse at carotide artery • ►► 6- If no sign of circulation (no pulse); start chest compression --------------------------------------------------------------------- • 1- 2 rescuer CPR : 15 compression - 2 ventilation. • Rate of compression : 90- 100/min • At the end of compression 2 full breaths should be given; if endotracheal tube is inplace; 5 chest compression / 1 ventilation

  23. ABC of CPR

  24. Autamated External DFB.

  25. CPR: “The moment every thing is over or started again “That moment”(?!?):First-aid ( Semi-autamated DFB).

  26. --VF,-DFB and -Sinüs rhythm.-- “Geçmiş olsun”….

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