FRCA Notes


Cardiac Arrest

The definitive resource for management of cardiac arrest in the UK is the below-linked Resus Council guidelines.

For those wanting greater depth of reading Deranged Physiology is, as ever, the place to go, with a number of pages on the topic (see link below).

For the sake of brevity I've not reproduced these here, but instead rely on most anaesthetists to have both ALS qualifications (if not instructor status) and real-world experience.

The site hosts separate pages on the management of cardiac arrest in special circumstances, namely maternal cardiac arrest, intra-operatively , whilst pinned for neurosurgery , on CICU or for paediatric patients.

There's not yet been an SAQ/CRQ on cardiac arrest, but SBA/MTF questions on the topic are fairly common.

Resources


  • Chest compressions should have the following characteristics:
Factor Target
Rate 100 - 120bpm
Depth 1/3rd depth of the chest (or 5 - 6cm)
Release 100%
Time performing compressions >90%

  • Chest compressions are felt to work via:
    • Cardiac pump theory i.e. squeezing heart encouraging forward flow of blood
    • Thoracic pump theory i.e. squeezing lungs compresses veins but not arteries, leading to a pressure gradient and forward flow of blood

Adrenaline

  • Use of adrenaline is associated with a nearly 3x increased incidence of ROSC
  • Yet it doesn't lead to a significant increase in neurologically intact survival (95% confidence interval of OR crosses 1)

Amiodarone

  • Amiodarone is given to help transform defibrillation-refractory rhythms into defibrillation-sensitive ones; it does appear to improve response to defibrillation
  • Use of amiodarone is associated with an increased survival to hospital admission and possibly also hospital discharge
  • It can, however, cause profound vasodilation owing to the solvent it is prepared in (modern preparations may use different solvents)

Lidocaine

  • Lidocaine (1mg/kg) is second string to amiodarone and is used in situations where amiodarone can't be

Other drugs

  • Magnesium - for Torsades de pointes only
  • Potassium - for hypokalaemic arrest only
  • Thrombolytics - for suspected/confirmed massive PE only

  • Calcium - no evidence base for routine use
  • Sodium bicarbonate - no evidence base for routine use
  • Vasopressin - no evidence to support its use
  • Aminophylline - no evidence to support its use