ASL in perspective

Question 1

What is the 1st and second biggest single cause of death in the UK?

Answer 1

1st = Dementia
2nd = Ischaemic heart disease (IHD)

Question 2

Where do most cardiac arrests occur and what is usually the presumed cause?

Answer 2

Most cardiac arrests occur at home and are presumed to be cardiac in cause.

Question 3

List the percentage (%) frequency of the different presenting rhythm’s on initial recognition of an Out of hospital cardiac arrest

Answer 3

The presenting rhythm is non-shockable rhythm’s 75% of the time - 50% asystole, 25% PEA.

The presenting rhythm is a shockable rhythm only 25% of the time (VF/pVT).

Question 4

What is the percetange (%) chance of ROSC for an out of hospital cardiac arrest?

Worse yet what is the percentage chance of not only ROSC but survival rate discharged from hospital?

Answer 4

In those resuscitation is attempted 30% will achieve ROSC but only 9.7% will survive to go home from hospital.

Question 5

What is the frequency of in-hospital cardiac arrests ?

Answer 5

Approx. 1 per 1000 hospital admissions.

Question 6

What is the percentage (%) frequency of the different possible presenting rhythms at in-hospital cardiac arrests?

Answer 6

• 72% are non-shockable (50% asystole, 20% PEA).
• 17% are shockable (VF/pVT)
• 11% are indeterminant rhythms

Question 7

What is the overall suvival rates to discharge of in-hospital cardiac arrests?

Answer 7

23.9%

Question 8

When you consider the presenting rhythm at the cardiac arrest how does this change the suvival rates to discharge ?

Answer 8

• If shockable rhythm on presentation - survival rate is 50.6%
• If non-shockable rhythm on presentation - suvival rate is 14.4%

Question 9

What are the 3 main reasons for improved survival rates of in-hospital vs out of hospital cardiac arrests ?

Answer 9

1. Appropriate implementation of DNACPR’s
2. Improved guidelines
3. Imporved treatments available

Question 10

What are the 4 links that contribute to a successful outcome after a cardiac arrest and what is the name given to this?

Answer 10

The chain of survival
1. Early recognition and call for help
2. Early CPR (to buy time)
3. Early defibrillation (to restart the heart)
4. Post resuscitation care (to restore QOL)

Question 11

What does chest compressions and ventilation do?

Answer 11

It slows the rate of deterioration of the brain and heart.

Question 12

What does CPR (chest compressions and ventilation) do to the survival rates of out of hospital cardiac arrests?

Answer 12

Doubles it

Question 13

Is chest compression only CPR better than nothing?

Answer 13

Of course!

Question 14

For in-hospital cardiac arrest should you delay defibrillation (shockable rhythms (VF/pVT)) if ready and CPR hasnt started?

Answer 14

No! Defibrillate them.

CPR (compressions and ventilation) should have already been started immediately on recognition but if not then and pads are on then defibrillate them.

Question 15

What does early defibrillation (within 3-5 mins of cardiac arrest) do to the survival rates?

Answer 15

Improves them greatly - survival rates can be as high as 50-70% if defibrillated early.

Question 16

By how much does each minute of delay to early defibrillation affect survival rates?

Answer 16

Per minute the probability of survival to hospital discharge is reduced by 10-12%

Question 17

ROSC is important but what is the ultimate goal ?

Answer 17

To return the patient to a state of normal cerebral function, stable cardiac rhythm and normal haemodynamic function.

Question 18

Go over the ALS algorithm

Answer 18

Question 20

What time is aimed for to have recognised a cardiac arrest and attempted defibrillation within if appropriate i.e. shockable rhythm?

Answer 20

Within 3 minutes.