Cardiac arrest
| Classification according to ICD-10 | |
|---|---|
| I46.- | Cardiac arrest |
| I46.0 | Cardiac arrest with successful resuscitation |
| I46.1 | Sudden cardiac death, as described |
| I46.9 | Cardiac arrest, unspecified |
| ICD-10 online (WHO version 2019) | |
When cardiac arrest , often with cardiac arrest equated refers to the acute cessation of blood circulation through a suddenly occurred serious disturbance in the cardiovascular system. Approximately 10 to 15 seconds after a cardiac arrest occurs, the patient becomes unconscious and after 30 to 60 seconds the patient stops breathing. One then speaks of clinical death . This condition is potentially reversible and can be explained by the introduction of a cardiopulmonary resuscitation (CPR) therapy. However, resuscitation is not always successful, and the measures are only promising within a limited time window, depending on the ambient temperature and body size or age. Without successful resuscitation or mechanical maintenance of the circulatory functions, death occurs.
causes
In adults, cardiovascular arrest is primarily due to cardiovascular causes such as cardiac arrhythmias (in up to 80% of cases, ventricular fibrillation or ventricular tachycardia) or circulatory disorders (ischemia as in heart attack), with every cardiac arrest leading to cardiac arrest. In children, respiratory (respiratory) causes predominate (e.g. aspiration of foreign bodies). In a study in Scotland , the most common out-of-hospital cause of cardiac arrest in the sense of an emergency was sudden cardiac death due to a heart attack or cardiac arrhythmia , accounting for over 80% . Other causes are lung diseases , diseases of the brain such as B. a stroke or a pulmonary embolism . In nine percent, other reasons such as accidents , suffocation , poisoning , drowning , suicides or electrical accidents lead to cardiac arrest.
Distinction
Cardiac arrest, i.e. a failure of the blood supply to the body ( circulatory failure ), can be divided into several forms:
- Ventricular fibrillation , also known as ventricular fibrillation (VF): The muscle contraction is disturbed, the individual heart muscle cells work uncoordinated and independently of one another, so that no contraction of the entire heart muscle, which is important for ejection, can develop.
- Pulseless ventricular tachycardia (pVT): The heart beats so fast that it cannot fill up with blood adequately between two beats and therefore cannot pump.
- Hypodynamic heart failure ( weak action ): Bradycardia with insufficient (insufficient) ejection capacity
- Electromechanical decoupling , also known as electromechanical dissociation (EMD) or pulseless electrical activity (PEA): There is electrical activity in the cardiac muscle fibers, but these stimuli are hardly or not at all converted into mechanical heart actions (contractions).
- Asystole (real cardiac arrest): There is a complete failure of the electrical and mechanical heart actions.
Even if all forms effectively mean a failure of the pump function, differentiation is important for advanced therapy.
character
As sure signs are a cardiac arrest:
- Pulselessness of larger arteries ( common carotid or femoral artery );
- initially gasping ; this occurs with cardiac arrest (after approx. 20–30 seconds);
- Respiratory failure ; in the case of cardiac arrest, this occurs after approx. 30–60 seconds.
As unsafe characters are:
- Lack of reflexes
- dilated or light-rigid pupils (approx. 60 seconds),
- Cyanosis (gray-blue skin),
- Convulsions ,
- Pulselessness of the radial artery (wrist),
- Absence of audible heart sounds.
Unconsciousness occurs after a few seconds of cardiac arrest.
Occurrence
Sudden cardiac death continues to be a leading cause of death worldwide. Outside of the hospital (OHCA, Out of Hospital cardiac arrest), the frequency of cardiac arrest is given as an average of around 55 cases per 100,000 person-years. For in-hospital cardiac arrest (IHCA), the number varies between 1 and 5 per 1000 hospital admissions.
therapy
Cardiac arrest is an immediately life-threatening medical emergency and requires cardiopulmonary resuscitation to be initiated immediately.
In addition to the basic measures of cardiac massage and ventilation , which can also be carried out by laypeople and without special equipment, rapid extended therapy ( medication , defibrillation ), for example by the emergency services, is necessary. Therefore, an emergency call should be made as soon as possible after a person has become unconscious .
Resuscitation by laypeople plays a crucial role in the patient's treatment outcome. By the time the rescue service arrives, the lack of oxygen can already cause irreversible damage to the brain, which can only be delayed with adequate chest compressions and ventilation .
Individual evidence
- ^ Pschyrembel Clinical Dictionary . Founded by Willibald Pschyrembel. Edited by the publisher's dictionary editor. 255th edition. De Gruyter, Berlin 1986, ISBN 3-11-007916-X , p. 907 f.
- ↑ Harald Genzwürker, Jochen Hinkebein: Case book anesthesia, intensive care medicine and emergency medicine. Georg Thieme, Stuttgart / New York 2005, ISBN 3-13-139311-4 , p. 201.
- ↑ Harald Genzwürker, Jochen Hinkebein: Case book anesthesia, intensive care medicine and emergency medicine. Georg Thieme, Stuttgart / New York 2005, ISBN 3-13-139311-4 , p. 201.
- ↑ JP Pell, JM Sirel, AK Marsden et al .: Presentation, management, and outcome of out of hospital cardiopulmonary arrest: comparison by underlying aetiology. In: Heart. Volume 89, 2003, pp. 839-842. PMID 12860852
- ↑ D. Lunz, A. Philipp, YA Zausig: Preclinical eCPR (Extracorporeal Cardiopulmonary Resuscitation). In: Emergency Medicine up2date. 2017, 12 (3), pp. 255-266, doi: 10.1055 / s-0043-116762 . VNR 2760512017152374817.