2.2.1.

How to give an emergency help against cardiac arrest?

When encountering a victim of sudden adult cardiac arrest, the lone
rescuer must first recognize that the victim has experienced a cardiac arrest, based
on unresponsive- ness and lack of normal breathing. After recognition, the rescuer
should immediately activate the emergency re- sponse system, get an
AED/defibrillator, if available, and start CPR with chest compressions. If an AED
is not close by, the rescuer should proceed directly to CPR. If other rescuers are
present, the first rescuer should direct them to activate the emergency response
system and get the AED/defibrillator; the first rescuer should start CPR
immediately.

simplifies adult BLS for common people (not profesional)

When the AED/defibrillator arrives, apply the pads, if possible, without
interrupting chest compressions and turn the AED on. The AED will analyze
the rhythm and direct the rescuer either to provide a shock (ie, attempt
defibrillation) or to continue CPR.

If an AED/defibrillator is not available, continue CPR without

interruptions until more experienced rescuers as- sume care.
Recognition and Activation of Emergency Response
Prompt emergency activation and initiation of CPR re- quires rapid
recognition of cardiac arrest. A cardiac arrest victim is not responsive. Breathing
is absent or is not normal.18,19 Agonal gasps are common early after sudden
cardiac arrest and can be confused with normal breath- ing.2023 Pulse detection
alone is often unreliable, even when performed by trained rescuers, and it may
require additional time.24 27 Consequently, rescuers should start CPR
immediately if the adult victim is unresponsive and not breathing or not breathing
normally (ie, only gasping). The directive to look, listen, and feel for breathing
to aid recognition is no longer recommended.
Emergency dispatchers can and should assist in the assess- ment and direction to
start CPR. A healthcare profes- sional may incorporate additional information to
aid arrest recognition.
Chest Compressions
The prompt initiation of effective chest compressions is a fundamental aspect
of cardiac arrest resuscitation. CPR im- proves the victims chance of survival by
providing heart and brain circulation. Rescuers should perform chest
compressions for all victims in cardiac arrest, regardless of rescuer skill level,
victim characteristics, or available resources.
Rescuers should focus on delivering high-quality CPR:
providing chest compressions of adequate rate (at least 100/minute)
providing chest compressions of adequate depth
adults: a compression depth of at least 2 inches (5 cm)
infants and children: a depth of least one third the anterior-posterior (AP)
diameter of the chest or about 1 12 inches (4 cm) in infants and about 2 inches
(5 cm) in children
allowing complete chest recoil after each compression
minimizing interruptions in compressions

 avoiding excessive ventilation

If multiple rescuers are available, they should rotate the task of compressions
every 2 minutes.
Airway and Ventilations
Opening the airway (with a head tiltchin lift or jaw thrust) followed by rescue
breaths can improve oxygena- tion and ventilation. However, these maneuvers
can be technically challenging and require interruptions of chest compressions,
particularly for a lone rescuer who has not been trained. Thus, the untrained
rescuer will provide Hands-Only (compression-only) CPR (ie, compressions
without ventilations), and the lone rescuer who is able should open the airway and
give rescue breaths with chest compressions. Ventilations should be provided if
the victim has a high likelihood of an asphyxial cause of the arrest (eg, infant,
child, or drowning victim).
Once an advanced airway is in place, healthcare provid- ers will deliver
ventilations at a regular rate 1 breath every 6 to 8 seconds (8 to 10
breaths/minute) and chest com- pressions can be delivered without interruption.
Defibrillation
The victims chance of survival decreases with an increasing interval between
the arrest and defibrillation.30,31 Thus early defibrillation remains the
cornerstone therapy for ventricular fibrillation and pulseless ventricular
tachycardia. Community and hospital strategies should aggressively work to
reduce the interval between arrest and defibrillation.
One of the determinants of successful defibrillation is the effectiveness of
chest compressions. Defibrillation outcome is improved if interruptions (for
rhythm assess- ment, defibrillation, or advanced care) in chest compres- sions are
kept to a minimum.

Adult BLS Healthcare provider algorithm

Translating Resuscitation Science Into Practice
In a community setting, the sole trained layperson responding to a cardiac
arrest victim needs to perform an ordered sequence of CPR steps. Laypersons can
learn these skills online and in courses.
In contrast, in a highly specialized environment, such as a critical care unit
of a hospital, many of the individual compo- nents of CPR (compressionventilation-defibrillation) may be managed simultaneously. This approach
requires choreog- raphy among many highly-trained rescuers who work as an
integrated team.
In the prehospital setting, the order of the CPR components performed by
the healthcare provider may switch between a sequenced and choreographed
model depending on the pro- ficiency of the provider and the availability of
resources. (Travers et al, 2010).

4. What should you do after doing initial assessment and resuscitation?

Integrated Emergency Management Systems
Professional emergency management in the modern era should be performed using
the concepts of Comprehensive Emergency Management (CEM). CEM is the practice of
handling emergency tasks in all phases for all types of disaster agents. This is referring to
using an all-hazards approach in planning the strategies, tactics, and procedures that are to be
used in all phases of a disaster. There are 3 part of emergency management system pre
hospital care, hospital care and refferal system. Traditionally, there have been four phases of
a disaster: mitigation, preparedness, response, and recovery. In addition to these four phases,
some models of emergency management add prevention as a fifth phase in disasters (Perry,
2007, p. 3). The Federal Emergency Management Agency (FEMA) has now adopted a
comprehensive approach to coordinated preparedness against all threats and hazards, which
consists of five mission areas: prevention, protection, mitigation, response, and recovery
(FEMA, 2012).

Emergency Response success depends on 4 factors

1. Speed was found for patients Emergency
2. The speed and Response Officers
3. Ability and Quality
4. Speed ask for Help

There are 14 suggestion for emergency medical services integration of health services,
EMS research, legislation and regulation, system finance, human resources, medical
direction, education systems, public education, prevention, public access, communication
systems, clinical care, information system and evaluation.

Activate the EMS system

Location.

Telephone number.

What happened.

Number of persons who need help.

Condition of the victim(s).

What aid is being given(s).

Any other information requested.

Post Cardiac Arrest Care

After doing initial assessment and cardiac pulmonary resuscitation, there are two possibilities
that occurs to the victim. He can get Return of Spontaneous Circulation (ROSC) or not. The
action after ROSC called post-cardiac arrest care.
The central principles of post-arrest care are to identify and treat the underlying etiology of
the cardiac arrest, to mitigate ischemia-reperfusion injury and prevent secondary organ injury,
and to make accurate estimates of prognosis to guide the clinical team and to inform the
family when selecting goals of continued care. (Neumar et al., 2015) Postcardiac arrest care
is a critical component of advanced life support. Most deaths occur during the first 24 hours
after cardiac arrest.

Figure by: American Heart Association (2010)

The provider of CPR should ensure an adequate airway and support breathing immediately
after ROSC. Unconscious patients usually require an advanced airway for mechanical support
of breathing. It may be necessary to replace a supraglottic airway used for initial resuscitation
with an endotracheal tube, although the timing of replacement may vary. Methods for
securing an advanced airway are discussed in Part 8.1: Airway Management, but several
simple maneuvers deserve consideration. For example, rescuers and long-term hospital
providers should avoid using ties that pass circumferentially around the patient's neck,
potentially obstructing venous return from the brain. They should also elevate the head of the
bed 30 if tolerated to reduce the incidence of cerebral edema, aspiration, and ventilatoryassociated pneumonia. Correct placement of an advanced airway, particularly during patient
transport, should be monitored using waveform capnography as described in other sections of
the 2010 AHA Guidelines for CPR and ECC. Oxygenation of the patient should be monitored
continuously with pulse oximetry.
Although 100% oxygen may have been used during initial resuscitation, providers should
titrate inspired oxygen to the lowest level required to achieve an arterial oxygen saturation of
94%, so as to avoid potential oxygen toxicity. It is recognized that titration of inspired
oxygen may not be possible immediately after out-of-hospital cardiac arrest until the patient
is transported to the emergency department or, in the case of in-hospital arrest, the intensive

care unit (ICU). Hyperventilation or overbagging the patient is common after cardiac arrest
and should be avoided because of potential adverse hemodynamic effects. Hyperventilation
increases intrathoracic pressure and inversely lowers cardiac output. The decrease in PaCO2
seen with hyperventilation can also potentially decrease cerebral blood flow directly.
Ventilation may be started at 10 to 12 breaths per minute and titrated to achieve a PetCO2 of
35 to 40 mm Hg or a PaCO2 of 40 to 45 mm Hg.
The clinician should assess vital signs and monitor for recurrent cardiac arrhythmias.
Continuous electrocardiographic (ECG) monitoring should continue after ROSC, during
transport, and throughout ICU care until stability has been achieved. Intravenous (IV) access
should be obtained if not already established and the position and function of any intravenous
catheter verified. IV lines should be promptly established to replace emergent intraosseous
access achieved during resuscitation. If the patient is hypotensive (systolic blood pressure
<90 mm Hg), fluid boluses can be considered. Cold fluid may be used if therapeutic
hypothermia is elected. Vasoactive drug infusions such as dopamine, norepinephrine, or
epinephrine may be initiated if necessary and titrated to achieve a minimum systolic blood
pressure of 90 mm Hg or a mean arterial pressure of 65 mm Hg.
Brain injury and cardiovascular instability are the major determinants of survival after cardiac
arrest. Because therapeutic hypothermia is the only intervention demonstrated to improve
neurological recovery, it should be considered for any patient who is unable to follow verbal
commands after ROSC. The patient should be transported to a facility that reliably provides
this therapy in addition to coronary reperfusion (eg, PCI) and other goal-directed postarrest
care therapies.
Overall the most common cause of cardiac arrest is cardiovascular disease and coronary
ischemia. Therefore, a 12-lead ECG should be obtained as soon as possible to detect ST
elevation or new or presumably new left bundle-branch block. When there is high suspicion
of acute myocardial infarction (AMI), local protocols for treatment of AMI and coronary
reperfusion should be activated. Even in the absence of ST elevation, medical or
interventional treatments may be considered for treatment of ACS and should not be deferred
in the presence of coma or in conjunction with hypothermia. Concurrent PCI and
hypothermia are safe, with good outcomes reported for some comatose patients who undergo
PCI.

Patients who are unconscious or unresponsive after cardiac arrest should be directed to an
inpatient critical-care facility with a comprehensive care plan that includes acute
cardiovascular interventions, use of therapeutic hypothermia, standardized medical goaldirected therapies, and advanced neurological monitoring and care. Neurological prognosis
may be difficult to determine during the first 72 hours, even for patients who are not
undergoing therapeutic hypothermia. This time frame for prognostication is likely to be
extended in patients being cooled. Many initially comatose survivors of cardiac arrest have
the potential for full recovery such that they are able to lead normal lives. Between 20% and
50% or more of survivors of out-of-hospital cardiac arrest who are comatose on arrival at the
hospital may have good one-year neurological outcome. Therefore, it is important to place
patients in a hospital critical-care unit where expert care and neurological evaluation can be
performed and where appropriate testing to aid prognosis is available and performed in a
timely manner.
Attention should be directed to treating the precipitating cause of cardiac arrest after ROSC.
The provider should initiate or request studies that will further aid in evaluation of the patient.
It is important to identify and treat any cardiac, electrolyte, toxicological, pulmonary, and
neurological precipitants of arrest. The clinician may find it helpful to review the H's and T's
mnemonic to recall factors that may contribute to cardiac arrest or complicate resuscitation or
postresuscitation care: hypovolemia, hypoxia, hydrogen ion (acidosis of any etiology),
hyper-/hypokalemia, moderate to severe hypothermia, toxins, tamponade (cardiac), tension
pneumothorax, and thrombosis of the coronary or pulmonary vasculature. (Peberdy et al.,
2010)
1

Pathophysiology of chest pain

Chest pain is discomfort or pain that you feel anywhere along the front of your body
between your neck and upper abdomen (Michael A. Chen, 2014). There are many possible
causes of chest pain. Any organ or tissue in your chest can be the source of pain, including
your heart, lungs, esophagus, muscles, ribs, tendons, or nerves. Pain may also spread to the
chest from the neck, abdomen, and back. Due to our group opinion of the possible causes
(heart attack or cardiac arrest), we will explain more about cardiac chest pain.
Heart or blood vessel problems that can cause chest pain (Michael A. Chen, 2014):

Angina or a heart attack: The most common symptom is chest

pain that may feel like tightness, heavy pressure, squeezing, or

crushing pain. The pain may spread to the arm, shoulder, jaw, or
back.

A tear in the wall of the aorta, the large blood vessel that takes
blood from the heart to the rest of the body (aortic dissection)
causes sudden, severe pain in the chest and upper back.

Swelling (inflammation) in the sac that surrounds the heart

(pericarditis) causes pain in the center part of the chest.

Angina is chest pain or discomfort caused when your heart muscle doesn't get enough
oxygen-rich blood (Heart.org, 2015). It may feel like pressure or squeezing in your chest. The
discomfort also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even
feel like indigestion.
But, angina is not a disease. It is a symptom of an underlying heart problem, usually
coronary heart disease (CHD).There are many types of angina, including microvascular
angina, Prinzmetal's angina, stable angina, unstable angina and variant angina.
Angina can also be a symptom of coronary microvascular disease (MVD). This is
heart disease that affects the hearts smallest coronary arteries and is more likely to affect
women than men.
Types of Angina - Knowing the types of angina and how they differ is important.

Stable Angina / Angina Pectoris

Unstable Angina

Variant (Prinzmetal) Angina

Microvascular Angina

If youre at risk for heart disease or coronary MVD, youre also at risk for angina. The
major risk factors for heart disease and coronary MVD include:

Unhealthy cholesterol levels

High blood pressure

Smoking

Diabetes

Overweight or obesity

Metabolic syndrome

Inactivity

Unhealthy diet

Older age (The risk increases for men after 45 years of age and for
women after 55 years of age.)

Family history of early heart disease

Stable angina is less serious than unstable angina, but it can be very painful or
uncomfortable (Michael A. Chen, 2014).
There are many risk factors for coronary artery disease. Some include:

Diabetes

High blood pressure

High LDL cholesterol and low HDL cholesterol

Smoking

Anything that makes the heart muscle need more oxygen or reduces the amount of
oxygen it receives can cause an angina attack in someone with heart disease, including:

Cold weather

Exercise

Emotional stress

Large meals

Other causes of angina include:

Abnormal heart rhythms (your heart beats very quickly or your heart
rhythm is not regular)

Anemia

Coronary artery spasm (also called Prinzmetal's angina)

Heart failure

Heart valve disease

Hyperthyroidism (overactive thyroid)

Symptoms
Symptoms of stable angina are most often predictable. This means that the same
amount of exercise or activity may cause your angina to occur. Your angina should improve
or go away when you stop or slow down the exercise.

The most common symptom is chest pain that occurs behind the breastbone or
slightly to the left of it. The pain of stable angina usually begins slowly and gets worse over
the next few minutes before going away.
Typically, the chest pain feels like tightness, heavy pressure, squeezing, or a crushing
feeling. It may spread to the:

Arm (most often the left)

Back

Jaw

Neck

Shoulder

Some people say the pain feels like gas or indigestion.

Less common symptoms of angina may include:

Fatigue

Shortness of breath

Weakness

Dizziness or light-headedness

Nausea, vomiting, and sweating

Palpitations

Pain from stable angina:

Most often comes on after activity or stress

Lasts an average of 1 to 15 minutes

Is relieved with rest or a medicine called nitroglycerin

Angina attacks can occur at any time during the day. Most occur between 6 a.m. and
noon.

Chest pain
Chest pain is discomfort or pain that you feel anywhere along the front of your body between
your neck and upper abdomen.
Considerations

Many people with chest pain fear a heart attack. However, there are many possible causes of
chest pain. Some causes are not dangerous to your health, while other causes are serious
and, in some cases, life-threatening.
Any organ or tissue in your chest can be the source of pain, including your heart, lungs,
esophagus, muscles, ribs, tendons, or nerves. Pain may also spread to the chest from the neck,
abdomen, and back.
Causes
Heart or blood vessel problems that can cause chest pain:

Angina or a heart attack: The most common symptom is chest pain that may feel like
tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the arm,
shoulder, jaw, or back.

A tear in the wall of the aorta, the large blood vessel that takes blood from the heart to the rest
of the body (aortic dissection) causes sudden, severe pain in the chest and upper back.

Swelling (inflammation) in the sac that surrounds the heart (pericarditis) causes pain in the
center part of the chest.
Lung problems that can cause chest pain:

A blood clot in the lung (pulmonary embolism)

Collapse of the lung (pneumothorax)

Pneumonia causes a sharp chest pain that often gets worse when you take a deep breath or
cough.

Swelling of the lining around the lung (pleurisy) can cause chest pain that usually feels sharp,
and often gets worse when you take a deep breath or cough.
Other causes of chest pain:

Panic attack, which often occurs with fast breathing

Inflammation where the ribs join the breast bone or sternum (costochondritis)

Shingles, which causes sharp, tingling pain on one side that stretches from the chest to the
back, and may cause a rash

Strain of the muscles and tendons between the ribs

Chest pain can also be due to the following digestive system problems:

Spasms or narrowing of the esophagus (the tube that carries food from the mouth to the
stomach)

Gallstones cause pain that gets worse after a meal (most often a fatty meal).

Heartburn or gastroesophageal reflux (GERD)

Stomach ulcer or gastritis: Burning pain occurs if your stomach is empty and feels better
when you eat food
In children, most chest pain is not caused by the heart.
Home Care
For most causes of chest pain, it is best to check with your doctor or nurse before treating
yourself at home.

When to Contact a Medical Professional

Call 911 if:

You have sudden crushing, squeezing, tightening, or pressure in your chest.

Pain spreads (radiates) to your jaw, left arm, or between your shoulder blades.

You have nausea, dizziness, sweating, a racing heart, or shortness of breath.

You know you have angina and your chest discomfort is suddenly more intense, brought on
by lighter activity, or lasts longer than usual.

Your angina symptoms occur while you are at rest.

You have sudden, sharp chest pain with shortness of breath, especially after a long trip, a
stretch of bedrest (for example, following an operation), or other lack of movement,
especially if one leg is swollen or more swollen than the other (this could be a blood clot, part
of which has moved to the lungs).

You have been diagnosed with a serious condition, such as heart attack or pulmonary
embolism.
Your risk of having a heart attack is greater if:

You have a family history of heart disease

You smoke, use cocaine, or are overweight

You have high cholesterol, high blood pressure, or diabetes

You already have heart disease

Call your doctor if:

You have a fever or a cough that produces yellow-green phlegm

You have chest pain that is severe and does not go away

You are having problems swallowing

Chest pain lasts longer than 3 to 5 days

What to Expect at Your Office Visit
Your doctor may ask questions such as:

Is the pain between the shoulder blades? Under the breast bone? Does the pain change
location? Is it on one side only?

How would you describe the pain? (severe, tearing or ripping, sharp, stabbing, burning,
squeezing, tight, pressure-like, crushing, aching, dull, heavy)

Does it begin suddenly? Does the pain occur at the same time each day?

Does the pain get better or worse when you move?

Can you make the pain happen by pressing on a part of your chest?

Is the pain getting worse? How long does the pain last?

Does the pain go from your chest into your shoulder, arm, neck, jaw, or back?

Is the pain worse when you are breathing deeply, coughing, eating, or bending?

Is the pain worse when you are exercising? Is it better after you rest? Does it go away
completely, or is there just less pain?

Is the pain better after you take nitroglycerin medicine? After you eat or take antacids? After
you belch?

What other symptoms do you have?

The types of tests that are done depend on the cause of the pain, and what other medical
problems or risk factors you have.
Alternative Names
Chest tightness; Chest pressure; Chest discomfortChest tightness; Chest pressure; Chest
discomfort

Sumber: https://www.nlm.nih.gov/medlineplus/ency/article/003079.htm
Via: all valid
Michael A. Chen, MD, PhD 2014

Ventricular fibrillation
Ventricular fibrillation (VF) is a severely abnormal heart rhythm (arrhythmia) that is life
threatening.
Causes

The heart pumps blood to the lungs, brain, and other organs. If the heartbeat is interrupted,
even for a few seconds, it can lead to fainting (syncope) or cardiac arrest.
Fibrillation is an uncontrolled twitching or quivering of muscle fibers (fibrils). When it
occurs in the lower chambers of the heart, it is called ventricular fibrillation. During
ventricular fibrillation, blood is not pumped from the heart. Sudden cardiac death results.
The most common cause of VF is a heart attack. However, VF can occur whenever the heart
muscle does not get enough oxygen for any reason. Conditions that can lead to VF include:

Electrocution accidents or injury to the heart

Heart attack

Heart disease that is present at birth (congenital)

Heart muscle disease, including cardiomyopathies

Heart surgery

Narrowed coronary arteries

Sudden cardiac death (commotio cordis); most often occurs in athletes who have had an
injury over the surface of the heart

Medications
Most people with VF have no history of heart disease. However, they often have heart disease
risk factors, such as smoking, high blood pressure, and diabetes.
Symptoms
A person who has a VF episode can suddenly collapse or become unconscious. This happens
because the brain and muscles are not receiving blood from the heart.
The following symptoms may occur within minutes to 1 hour before the collapse:

Chest pain

Dizziness

Nausea

Rapid heartbeat

Shortness of breath
Exams and Tests
A cardiac monitor will show a very disorganized ("chaotic") heart rhythm.
Tests will be done to look for the cause of the VF.
Treatment
Ventricular fibrillation is a medical emergency. It must be treated immediately to save a
person's life.
Call for emergency help (such as 911) if a person who is having a VF episode collapses at
home or becomes unconscious.

While waiting for help, place the person's head and neck in line with the rest of the body to
help make breathing easier. Start CPR by doing chest compressions ("push hard and push
fast").

Continue to do this until the person becomes alert or help arrives.

VF is treated by delivering a quick electric shock through the chest. It is done using a device
called an external defibrillator. The electric shock can immediately restore the heartbeat to a
normal rhythm, and should be done as quickly as possible. Many public places now have
these machines.
Medicines may be given to control the heartbeat and heart function.
An implantable cardioverter defibrillator (ICD) is a device that can be implanted in the chest
wall of people who are at risk for this serious rhythm disorder The ICD detects the dangerous
heart rhythm and quickly sends a shock to correct it. It is a good idea for family members and
friends of people who have had VF and heart disease to take a CPR course. CPR courses are
available through the American Red Cross, hospitals, or the American Heart Association.
Outlook (Prognosis)

VF will lead to death within a few minutes unless it is treated quickly and properly. Even
then, long-term survival for people who live through a VF attack outside of the hospital is
low.
People who have survived VF may be in a coma or have long-term damage
Sumber: https://www.nlm.nih.gov/medlineplus/ency/article/007200.htm
Via: All valid
Michael A. Chen, MD, PhD 2014

Semua sitasinya pake chen,2014

Smoking is one of risk factors for Coronaria Heart Disease (CHD). Smoking can increase the risk of stroke,
CHD, and impotent two times, the risk of death cause undiagnosted CHD three times, the risk of Perifer
Arterial Disease more than three times, and the risk of aortic aneurism four times.
Based on the Framingham study, it said that the risk of the death cause cardiovascular disease will
decrease until 24% by stop smoking habit (Depkes RI, 2007). Morbidity and mortality because CHD on
smokers are higher than non-smokers. On that study is also said that the sudden death cause CHD on
smokers is occurred ten times often than non-smokers.
Smoking is also related with low level of HDL cholesterol in plasma so that increase the risk to get CHD.
Based on some studies, smoking can increase the risk to get CHD and other cardiovascular disease,
because:
1. Nicotine cause catecholamine mobilizing so that adding trombocyte reaction and lead damage on
artery wall. Glicoprotein of tobacco can induce hypersensitivity of artery wall. Nicotine is also induce
secretion of adrenaline that stimulate heart rate and blood pressure.
2. Smoke contain carbon monoxide (CO) that had higher affinity to hemoglobin than oxygen (O 2) so that
decrease the capacity of red blood cell to take oxygen to tissues including to heart. It can caused artery
hypoxia. (Kusmana, et al., 2007)
3. Smoking can hide angina, the chest pain, that can be marker or signal of heart disease. (Depkes RI,
2007)
Smoking is also related with hypertension. Chemical substances like nicotine and CO entered into blood
flow and damage endotel of artery, lead to arterosclerosis and hypertension. (Zakiyah, 2008)

Criteria for Not Starting CPR

R

The patient has a valid DNAR order.

The patient has signs of irreversible death: rigor mortis, decapitation, or dependent
lividity.

No physiological benefit can be expected because the vital functions have deteriorated
despite maximal therapy for such conditions as progressive septic or cardiogenic shock.

Withholding attempts to resuscitate in the delivery room is appropriate for newly born

infants with Confirmed gestation <23 weeks or birthweight <400 g Anencephaly

Confirmed trisomy 13 or 18
R

(AHA, 2000)
American

Heart

Association.

2000.

10.1161/01.CIR.102.suppl_1.I-12.

Circulation;

102:

Accessed

I-12-I-i-21
from

doi:
:

http://circ.ahajournals.org/content/102/suppl_1/I-12.full Accessed at: 2 November 2015

R
Criteria for Terminating Resuscitative Efforts
The most important factor associated with poor outcome is time of resuscitative efforts. The
chance of discharge from the hospital alive and neurologically intact diminishes as
resuscitation time increases. Clinicians must constantly reassess patient status. The
responsible clinician should stop the resuscitative effort when he or she determines with a
high degree of certainty that the arrest victim will not respond to further ACLS efforts. No
reliable criteria are available to determine neurological outcome during cardiac arrest.
Available scientific studies have shown that, in the absence of mitigating factors, prolonged
resuscitative efforts for adults and children are unlikely to be successful and can be
discontinued if there is no return of spontaneous circulation at any time during 30 minutes of
cumulative ACLS. If return of spontaneous circulation of any duration occurs at any time,
however, it may be appropriate to consider extending the resuscitative effort. Other issues,
such as drug overdose and severe prearrest hypothermia (eg, near-drowning in icy water),
should be considered when determining whether to extend resuscitative efforts.
For the newly born infant, discontinuation of resuscitative efforts may be appropriate if
spontaneous circulation has not returned after 15 minutes. Lack of response to intensive
resuscitation for >10 minutes carries an extremely poor prognosis for survival or survival
without disability.
R

(AHA, 2000)
American

Heart

Association.

10.1161/01.CIR.102.suppl_1.I-12.

2000.

Circulation;
Accessed

102:

I-12-I-i-21
from

http://circ.ahajournals.org/content/102/suppl_1/I-12.full Accessed at: 2 November 2015

doi:
:

CPR effect on heart

When someones heart has stopped, blood is no longer circulated through the body and
therefore hardly any of the oxygen in the blood is used. The person was breathing normally
only seconds ago, so their blood contains enough oxygen to tide them over for several
minutes. However, it is crucial to deliver blood and oxygen to the brain by performing chest
compressions continuously. CPR also buys time until paramedics come and restore the
normal pumping of heart. (Arizona University, 2015 and National Heart Foundation of
Australia, 2011)