Cardiopulmonary Arrest for Certified Emergency Nursing (CEN)

Cardiopulmonary Arrest:

Definition/Etiology:

-Cessation of adequate heart function and respirations

-Without reversal will result in death

-Heart is not beating, lungs aren’t breathing

Causes:

• Cardiac
  • MI, other
• Respiratory
  • Obstruction, airway disease (asthma, COPD)
  • PE
  • Muscle weakness
• Trauma
  • Hemorrhage and shock (poor prognosis)
  • Structural damage
  • Spinal cord injury

>60% of cardiac arrests caused by acute myocardial infarction (AMI)

Pathophysiology:

• Pump failure
• Unexpected interruption of mechanical activity
• Inefficient blood flow, no palpable pulses

Clinical Presentation:

• Preceding cardiopulmonary arrest – palpitations, shortness of breath, nausea, and chest pain
• cardiopulmonary arrest diagnosis – loss of Central pulse (including carotid/femoral on adults, brachial on infants) and spontaneous respirations

Collaborative Management:

BLS:

• Recognize
• Activate emergency response
• High quality chest compressions (Fast, hard, allow for chest recoil)
• Rescue breathing
• Rapid defibrillation
  • When either a basic AED or more complex one in “basic mode,” the equipment knows when to shock. For ACLS, certified providers (could be nurses) can adjust/customize

ABCs:

• Airway – airway patency, do not delay compressions or defibrillation for advanced airway insertion
• Breathing – bag-mask ventilation (assess rise and fall of chest)
  • Ratio chest compressions: ventilations = 30:1
  • Advanced airway – q5-6 seconds
  • No hyperventilation (increases intrathoracic pressure, decreases venous return to heart
• Circulation – defibrillation and medication

Defibrillation:

• Early defibrillation; immediately resume CPR

Medications:

• Epinephrine – 1mg IV/IO q3-5 minutes
• Amiodarone – 300mg (first dose); after 5 minutes – 150mg (second dose)

Correct causes of pump failure – think Hs and Ts:
Pregnancy Considerations

• Follow standard AHA Advanced Cardiovascular Life Support (ACLS) guidelines
• Provide chest compressions slightly higher anatomically
• Manually displace the uterus to the left to prevent or correct vena cava syndrome
• Initiate IV access above the level of diaphragm
• Remove fetal monitoring devices prior to defibrillation
• Identify and treat the contributing factors
• Consider emergency Cesarean section if no maternal return of spontaneous circulation within 4 minutes of arrest

Ultimate goal = return of spontaneous circulation (ROSC)

Evaluation | Patient Monitoring | Education:

After ROSC

• Temperature management/therapeutic hypothermia
  • Improves neurologic recovery
  • Target temperatures of 32–34°C for 12–24 hours
  • Continuous core temperature observation (indwelling urinary catheter
  • Control shivering (prevent increased body temperature)
• Sedation, analgesia, and neuromuscular blockade
• Monitor electrolytes and glucose and correct as needed

Linchpins: (Key Points)

The pump isn’t pumping – think mechanical failure

• Heart muscle is not pumping effectively
• Circulation impaired
• Need CPR (take over pumping action until cause of failure corrected)
• ROSC = targeted temperature management