Cardiac tamponade in circulatory arrest emergency

This is an automatically translated article.

The article was professionally consulted with Specialist Doctor II Nguyen Quoc Viet - Interventional Cardiologist - Department of Medical Examination & Internal Medicine - Vinmec Danang International General Hospital.
Circulatory arrest is a very serious emergency. At that time, the heart can't contract, leading to the lack of blood supply to the organs in the body, especially the brain, the coronary system, the lungs... So cardiac compression in emergency circulatory arrest has a role to play. how?

1. What is circulatory arrest?

Circulatory arrest is a phenomenon where the heart loses function, does not contract and immediately leads to respiratory and consciousness disorders. The states of circulatory arrest include three basic types: asystole, ventricular fibrillation, and electromyographic dissociation.
Circulatory arrest can occur anywhere, including in-hospital and out-of-hospital with very severe prognosis, high risk of death if not promptly treated. The most common cause of cardiac arrest is cardiac arrhythmia due to ischemic heart disease.
Forms of circulatory arrest seen in hospital:
Electromyography dissociation or asystole due to hypoxia or hypotension; Ventricular fibrillation, pulseless ventricular tachycardia; The survival rate of patients who can be discharged is about 17%. Cardiac arrest patterns encountered outside the hospital:
ventricular fibrillation or pulseless ventricular tachycardia due to ischemic heart disease: up to 45% of cases; The survival rate is very low: only about 1 - 10%. In particular, complete circulatory arrest can occur suddenly in a patient with a perfectly healthy heart. At that time, the factors and causes of cardiac arrest can be in accidents caused by electric shock, drowning, anaphylaxis or multiple trauma... Besides, circulatory arrest is mostly the end result of heart failure. a chronic end-stage disease such as cancer, cirrhosis, heart failure, kidney failure...
In medicine, the term circulatory arrest emergency also has other names such as emergency cardiac arrest, resuscitation clinical death, cardiopulmonary resuscitation, cardiopulmonary resuscitation...

2. General principles of circulatory arrest emergency protocol

The principle of the emergency regimen for cardiac arrest requires the operator to start the procedure and perform emergency operations as soon as a person is detected with signs of suspected cardiac arrest. The emergency person must both determine if there is a cardiac arrest, call for support from people around, and immediately perform basic cardiopulmonary resuscitation. Principles in the emergency cardiac arrest regimen include:
The best condition is to have 1 person take the lead with the task of assigning others and organizing emergency work to stop circulatory arrest in the correct order, make sure everything goes in sync; During the emergency of circulatory arrest, it is necessary to record the necessary information and emergency procedures; The emergency space to stop circulation must be large enough to limit the concentration of non-participants, obstructing emergency work; Evaluate the effective respiratory-circulatory arrest emergency process when the most important goal is to provide oxygen to vital organs such as the brain, coronary system and other cellular organizations.
The patient has symptoms such as lips warm and pink again, pupils constrict (when the time of brain hypoxia has not taken place too long) and assess the patient's ability to recover. Even more positive signs are that the patient has signs of life such as being able to breathe on his own, his heart beating again, consciousness gradually recovering...
However, the emergency person who stops the circulation needs special attention. It means that the patient must have both signs of being oxygenated again (warm and pink lips) and moderate signs of brain cell damage (constricted pupils) for the emergency process to be assessed as effective. Therefore, the emergency process of circulatory arrest needs to be patient, and at the same time contact the nearest medical emergency or even both emergency and transport the patient to the nearest hospital.
It's not every emergency that is successful. In some severe cases, the first responders, if they have applied all the correct actions, are unable to transport the patient to the hospital or call for a medical emergency. Within 60 minutes, without the pupil completely constricting, the heart not beating again, the emergency process of circulatory arrest can be stopped and the patient is declared dead.

3. What to do when a patient stops circulation?

As soon as detecting that the patient has no breathing or abnormal breathing, the doctor needs to conduct an assessment of circulatory arrest, the time is not more than 10 seconds. In particular, the doctor does not waste time listening to the heart, taking the pulse, measuring the electrocardiogram or measuring the blood pressure, but must immediately start the emergency procedure for respiratory arrest in the order C-A-B
Emergency procedure to stop C-A-B:
Circulation: Apply chest compressions as soon as possible within 10 seconds of cardiac arrest, continue for at least 2 minutes and ensure proper compression , avoid interruptions; Airway (Airway): Pay attention to open the patient's airway, avoid obstruction with different causes; Breathing: Simultaneously with the process of squeezing the heart outside the chest is the act of breathing twice, 1 time lasting about 1 second, avoiding the phenomenon of excessive lung tension. Continue chest compressions and rescue breaths at a frequency of 30:2 in adults. The frequency of rescue breaths is about 5-6 seconds/time, if intubated, squeeze the balloon every 6-8 seconds/time).

4. Where is the location of cardiac compression in cardiac arrest emergency?

The emergency regimen for cardiac arrest includes the following basic requirements:
Patient's position: Lying supine on hard ground; The location of chest compressions in cardiac arrest is right in the middle of the chest; Presser position: Arms and forearms should be aligned to transmit pressure from their shoulders to the patient's chest; The rate of chest compressions is from 100 to 120 times per minute; The depth of each pressing is more than 5 cm; Make sure the chest expands after each compression; The ratio between chest compressions and rescue breaths is 30:2 (requires 2 rescuers); In case only 1 rescuer stops circulatory, only press the heart alone, avoiding interruption because of other movements; Cardiac arrest can provide continuous extrathoracic compression without giving rescue breaths. However, for children or people who are suffocated, it is imperative to give both chest compressions and rescue breaths.

5. Post-compression assessment in cardiac arrest emergency

The person performing CPR should minimize interruptions during compressions, and should only be assessed every 2 minutes in CPR. The pulse assessment should not exceed 10 seconds and the patient must be resuscitated after that. For non-professionals, it is not recommended to check the pulse, just perform continuous chest compressions and artificial respiration, do not need to check the pulse immediately after each shock, just continue to press the heart.

6. Possible disorders after circulatory arrest

Brain damage after circulatory arrest; Cardiac dysfunction; Systemic damage due to reperfusion/ischemia; Have diseases that cause circulatory arrest or a combination.

7. Post-care to restore circulation

After successful resuscitation of circulatory arrest, it is necessary to optimize ventilation and hemodynamic therapy for the patient;
Hypothermia; Immediate revascularization of coronary artery by catheter intervention; Blood sugar control; Neurological care and treatment: problems related to epilepsy, myoclonus, use of neuroprotective drugs...; Other forms of intensive care: care for kidney failure, adrenal insufficiency, infection (reflux pneumonia). In summary, circulatory arrest is a serious condition with low hospital discharge survival rate, requiring aggressive and reasonable management. Compression plays an extremely important role: it is necessary to apply chest compressions correctly, without interruption and early defibrillation.
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