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- The absence of effective mechanical cardiac activity leading to tissue hypoperfusion and cell death
- This section is not a substitute for an American Heart Association (AHA)-approved advanced cardiac life support (ACLS) course and is intended only as a quick reference.
- Synonym(s): “Code” or “Code Blue”
It is important to have an open dialogue with patients regarding their code status, that is, do not resuscitate (DNR) and/or do not intubate (DNI) orders.
Asphyxia is the most common precipitant of cardiac arrest in children due to hypoxia and hypercapnia. Impending arrest is often heralded by bradycardia.
- Left uterine displacement in combination with chest compressions can best be accomplished by placing the patient on a hard surface and manually pulling the uterus to the patient’s left and upward. This allows increased blood return to the heart. Consensus guidelines have a standard of 5 minutes for fetal delivery from emergency C-section in those patients unresponsive to cardiopulmonary resuscitation (CPR) (1)[C]. Delivery may be lifesaving for fetus and mother.
- Consider amniotic fluid embolism, eclampsia-related seizures, or flash pulmonary edema as precipitating factors.
- Predominant age: Risk increases with age.
- Predominant sex: male > female
0.5 to 1.5/1,000 persons per year
Etiology and Pathophysiology
- Asystole (confirm in two leads)
- Ventricular fibrillation (VF)
- Pulseless ventricular tachycardia (VT)
- Pulseless electrical activity (PEA)
- Consider possible reversible causes (6 Hs and 5 Ts):
- Hypoxia, hypovolemia, hyper- and hypokalemia, (H+) (acidosis), hypothermia, hypoglycemia
- Cardiac tamponade, tension pneumothorax, thrombosis (pulmonary embolism, coronary), toxins (medications and overdoses), trauma
- Male gender
- Advanced age
- Hypertension (HTN)
- Cigarette smoking
- Coronary artery disease
- Prolonged QT
Commonly Associated Conditions
- Coronary artery disease/acute coronary syndrome (ACS)
- Valvular heart disease
- Pulmonary embolism