What is Cardiopulmonary Arrest in Adults (Heart Attack)?
Cardiopulmonary arrest (CPA), also called cardiac arrest or circulatory arrest, is when effective breathing and blood circulation stop. In adults, it mostly happens because of a problem in the heart. The culprit behind 50 to 80% of CPA cases is known as ventricular fibrillation (VF), a dangerous heart rhythm issue. Other less common issues causing irregular heart rhythm include Pulseless electrical activity (PEA), and a state of no electrical activity in the heart (asystole). A very rare cause is a heart rhythm condition called pulseless sustained ventricular tachycardia (VT). CPA is an emergency that can cause sudden death if not treated immediately. However, there’s hope because CPA can be halted using cardiopulmonary resuscitation (CPR, a procedure to restore blood circulation and breathing), or other treatments like cardioversion or defibrillation (methods to restore normal heart rhythm), or setting the heart pace with a device.
The American Heart Association frequently provides updates on how to perform basic life support (help given to a person having difficulty breathing, with the goal of maintaining circulation and breathing until medical help arrives) and quality CPR on adults. No matter what causes CPA, the first step is to immediately start CPR and monitor the heart, which will guide the course of treatment. Unfortunately, evidence shows that over 400,000 people die because of CPA in the US every year. These individuals may or may not have been previously diagnosed with a lung or heart disease.
What Causes Cardiopulmonary Arrest in Adults (Heart Attack)?
Cardiopulmonary arrest, also known as a heart attack, can be caused by various factors and these factors may vary depending on age and different populations. However, the people who have been identified to be most at risk are those who have a heart disease. Causes of a heart attack can be classified into three main categories: heart-related, breathing-related, and injury-related. It is believed that 75% of heart attacks are a result of coronary artery disease, also known as heart disease.
Heart Disease Causes:
Heart disease relates to any disease of the heart, of which the causes and forms are various:
– Abnormalities in the coronary artery, including unusual anatomy, sudden changes such as platelet aggregation or plaque fissuring, or long-term diseases like atherosclerosis or artery spasms.
– Myocardial Infarction or heart attacks which can be sudden (acute) or healed.
– Myocardial Hypertrophy or the thickening of the heart muscle, which can be secondary or part of hypertrophic cardiomyopathy (a form of heart disease).
– Valvular Heart Disease which is disease of the heart valves.
– Infiltrative and Inflammatory Disorders such as diseases that invade the heart muscle or non-infectious diseases that cause inflammation.
– Dilated Cardiomyopathy which is a disease that enlarges and weakens the heart.
– Electrophysiologic Abnormalities which involve the electric signals that coordinate your heartbeat.
– Inherited Disorders such as Early repolarization syndrome, Brugada syndrome, Catecholaminergic polymorphic ventricular tachycardia – all of which affect the heart’s rhythm.
– Heart Failure – This happens when your heart muscle doesn’t pump blood as well as it should.
– Congenital heart disease – Disease present from birth including Tetralogy of Fallot.
Breathing-related Causes:
Related to different lung conditions and diseases:
– Airway obstruction, including blockages due to severe asthma, Chronic Obstructive Pulmonary Disease (COPD), pulmonary edema, pulmonary hemorrhage, and pneumonia.
– Pulmonary Embolism, a sudden blockage in a lung artery.
– Respiratory muscle weakness caused by spinal cord injuries.
Injury-related Causes:
These are instances where an injury led to a heart attack.
Around 50% to 60% of the causes are heart-related while the second most common cause is respiratory insufficiency, accounting for around 15% to 40%.
Risk Factors and Frequency for Cardiopulmonary Arrest in Adults (Heart Attack)
Cardiac arrest can happen both inside and outside of hospitals and is categorized as in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). However, the total number of these incidents worldwide is not clearly known. In the U.S., over 290,000 IHCAs and 326,000 OHCAs happen among adults every year, and half of them are not observed.
Middle-aged men and women have different risks of cardiopulmonary arrest, but these differences decrease as they age. This change in risk goes hand in hand with the change in age-related risks for other symptoms of coronary heart disease (CHD) among males and females. The gap in symptoms of CHD between the genders narrows as they reach their 60s to 80s, and the higher risks among males also decrease. However, despite younger women having a lower risk, factors like diabetes, smoking, high cholesterol and blood pressure heavily increase their risk of CHD.
- Cardiac arrest can occur either in or out of hospitals.
- Every year, over 290,000 cases of IHCA and 326,000 cases of OHCA occur in adults in the U.S.
- Half of these cases are not observed.
- Middle-aged men and women have different risks of cardiopulmonary arrests, but these differences decrease with age.
- The differences in the risks among males and females for other symptoms of CHD also become closer as they reach their 60s to 80s.
- Despite younger women having a lower risk, factors like diabetes, smoking, high cholesterol, and high blood pressure can significantly raise their risk of CHD.
Signs and Symptoms of Cardiopulmonary Arrest in Adults (Heart Attack)
Cardiac arrest can sometimes be indicated by warning signs and symptoms. However, these signs are often overlooked or unrecognized. Those who have survived a cardiac arrest may not remember the event due to amnesia. For those who can recall the event, common signs include palpitations, trouble breathing, feelings of nausea, and chest pain.
Healthcare providers looking into a case of cardiac arrest should begin a comprehensive head-to-toe assessment as soon as possible. This can help determine the appropriate course of treatment. The exam can assist in diagnosing the cardiac arrest, and provide crucial information about the possible cause and outlook. A patient’s history can also help identify when the event occurred, what the patient was doing at the time, and any potential involvement of drugs.
In many cases, the key indicator of cardiac arrest is the loss of a pulse in the carotid artery in the neck. Yet, it’s important to note that mistakes can occur when checking the carotid pulse, regardless of whether the person checking is a bystander or a healthcare professional.
Testing for Cardiopulmonary Arrest in Adults (Heart Attack)
During cardiopulmonary resuscitation (CPR), which is a lifesaving procedure done when someone’s breathing or heartbeat has stopped, it’s important not to stop or interrupt the process for blood tests or imaging scans. However, there can be exceptions for tests that are done quickly right at the patient’s bedside. For example, tests for blood glucose (sugar levels in the blood) or serum potassium (a type of mineral/electrolyte in your blood) can be carried out if they don’t disrupt the ongoing CPR efforts.
Similarly, an ultrasound, which is an imaging method that uses sound waves to produce pictures of the inside of the body, can be used during CPR. This is a type of ‘point of care’ test, meaning it’s done at the patient’s bedside, rather than in a laboratory. The ultrasound can be used to look at the heart’s activity during CPR. Studies have shown that this can be beneficial in managing the patient’s treatment.
Treatment Options for Cardiopulmonary Arrest in Adults (Heart Attack)
When a person’s heart and lung functions suddenly stop, known as a “cardiopulmonary arrest”, there are five steps that medical professionals take to help the patient:
1. Initial evaluation and basic life support
2. Using a defibrillator (a device that gives the heart an electric shock)
3. Advanced life support
4. Care after resuscitation (returning the heart to normal functioning)
5. Long-term management
Anyone, from doctors, nurses and paramedics, to trained bystanders can assist with the initial evaluation and use a defibrillator. As the situation becomes more complex, skilled healthcare professionals are needed to provide advanced life support, care after resuscitation, and long-term management. Two key ways to reverse a cardiopulmonary arrest are performing CPR (chest compressions and rescue breaths) as soon as possible and using an Automated External Defibrillator (AED).
During the initial evaluation, responders check things like the patient’s consciousness, skin color, breathing, and pulse. Upon confirming cardiopulmonary arrest, immediate CPR is started and emergency medical services are called. If there’s a chance something’s blocking the patient’s airway, quick actions such as the Heimlich maneuver are recommended.
During use of an AED, laypersons like ambulance drivers, security guards, and other trained people can handle the AED. Recent research found that quicker use of AEDs in a crisis by non-medical responders can greatly increase survival rates.
Advanced cardiac life support steps in where basic life support leaves off. Skilled personnel use medication, more sophisticated airway devices, and identify and treat heart rhythm issues during this stage.
Post-resuscitation care starts once the patient’s heart begins to function normally again. The patient’s condition once they are stable is influenced by a variety of factors such as, the cause of their cardiac arrest and their overall health status before the event.
Finally, the long-term management phase involves appropriate evaluations and treatments, based on the cause of the patient’s cardiac arrest. This could involve medication management or even surgical intervention, all aimed at preventing future cardiac arrests. In some cases, a device known as an Implantable Cardioverter-Defibrillator (ICD) may be considered to help maintain a normal heart rhythm.
What else can Cardiopulmonary Arrest in Adults (Heart Attack) be?
When a person’s heart and breathing stop, which is called a cardiopulmonary arrest, they will not have a pulse and will be unconscious. However, there are other conditions that can look very similar to a cardiopulmonary arrest. These include passing out (syncope), having a seizure, and overdosing on certain drugs like opioids.
Medical professionals aim to identify and address any potential causes of the cardiopulmonary arrest that could potentially be reversed. These causes are often referred to as ‘H’s and ‘T’s, and they include:
- Low blood volume (Hypovolemia)
- Lack of oxygen (Hypoxia)
- Extremely low body temperature (Hypothermia)
- Too much or too little potassium in the body (Hypo/hyperkalemia)
- High levels of acid in the body (Acidosis)
- Built up pressure in the chest due to trapped air (Tension pneumothorax)
- Overdose from toxic drugs
- Blood clot in the lungs or elsewhere (Thromboembolism/pulmonary embolism)
- Blood clot in the heart (Thrombus/acute myocardial infarction)
- Pressure on the heart due to fluid buildup (Cardiac tamponade)
It’s crucial to recognize and treat these possible causes promptly to give the patient the best chance of survival.
What to expect with Cardiopulmonary Arrest in Adults (Heart Attack)
If someone’s heart suddenly stops (known as a cardiopulmonary arrest) and they receive immediate CPR and the use of a defibrillator to restart their heart, they’re more likely to survive and recover. This intervention has a greater impact on the survival rates of younger, healthier individuals compared to older individuals, particularly those with existing health conditions like ischemic heart disease (IHD), which is a condition where the heart muscle doesn’t get enough blood.
Possible Complications When Diagnosed with Cardiopulmonary Arrest in Adults (Heart Attack)
There are several complications that can occur during a procedure called cardiopulmonary resuscitation. The most prevalent complication is when an automated external defibrillator, a device used to deliver an electric shock to restart a heart, fails to work properly. Some other issues that can arise include difficulty in establishing a route for medications and fluids directly into a vein, damage to the ribs, lung punctures, air leaking into the space between the lungs, bleeding inside the chest, cut or torn lung tissue, heavy bleeding in the lungs, injury to major blood vessels, and heart compression due to fluid accumulation.
Potential Complications:
- Failure of the automated external defibrillator
- Difficulty in establishing venous access
- Rib fracture
- Lung puncture (pneumothorax)
- Air leakage into the space between the lungs (pneumomediastinum)
- Bleeding in the chest (hemothorax)
- Lung injury (laceration)
- Bleeding in the lungs (pulmonary hemorrhage)
- Major blood vessel injury
- Fluid accumulation causing heart compression (cardiac tamponade)
Preventing Cardiopulmonary Arrest in Adults (Heart Attack)
Most heart and lung failures happen outside of hospitals. Quickly starting CPR, which is a lifesaving technique that helps a person breathe and keeps their heart beating when it’s stopped or they’re not breathing, and using a defibrillator, a device that sends an electric shock to the heart to try and restore a normal heartbeat, can greatly improve a patient’s chances of survival. Even people who are not medical professionals but have been trained in CPR can make a big difference. However, sometimes even those who are trained might hesitate to start CPR because they aren’t sure or confident enough. This means there is a need for regular training sessions and workshops to improve their skills and confidence.
