Special Circumstances in Cardiac Arrests

Question 1

Name some special circumstances that could occur during an adult cardiac arrest

Answer 1

• Pregnancy
• Obesity
• High risk of infection
• Anaphylaxis
• Asthma

Question 2

Why might the delivery of effective CPR on an obese patient be challenging?

Answer 2

• Patient Access and Transportation
• Vascular Access
• Airway Management
• Quality of Chest Compressions
• Efficacy of Vasoactive Drugs
• Efficacy of Defibrillation

Question 3

How can you increase the effectiveness of CPR in obese patients?

Answer 3

• Provide chest compressions up to a maximum of 6cm
• Compressions may be necessary from the head end of the patient
• Change the rescuers performing compressions more frequently
  Consider escalating defibrillation energy to maximum for repeated shocks
• Ventilations should be performed using a two person technique

Question 4

What are the prevention of cardiac arrest methods in the deteriorating pregnant patient?

Answer 4

• Use the obstetric early warning scoring system
• ABCDE approach to assess and treat the patient
• Place the patient in the left lateral position or manually and gently displace the uterus to the left to relieve aortocaval compression
• Give oxygen guided by Sp02 to prevent hypoxia
• Give a fluid bolus if there is hypotension or evidence of hypovolaemia
• immediately re-evaluate the need for drugs being given
• Seek expert help early on
• identify and treat the underlying cause of cardiac arrest (e.g control of bleeding, sepsis)
• Give IV TXA for PPH

Question 5

What are the modifications to advanced life support for a pregnant patient?

Answer 5

• DO NOT withhold or terminate maternal resuscitation
• ALWAYS manage pregnant women in cardiac arrest at greater than 20 weeks gestation with manual displacement of the uterus to the maternal left
• If resuscitation attempts fail to achieve ROSC within 5 minutes, undertake a time critical transfer to the nearest ED
• Provide an early pre-alert to the ED to allow them to gather the maternity team

Question 6

What is an asthmatic induced cardiac arrest associated with?

Answer 6

• Severe bronchospasm and mucous plugging leading to asphyxia.
• Cardiac arrhythmias due to hypoxia, stimulant drug or electrolyte abnormalities
• Dynamic hyperinflation where a gradual build-up of pressure occurs which reduces venous return and blood pressure
• Tension pneumothorax (sometimes bilateral)

Question 7

In an Asthmatic cardiac arrest, as well as the standard ALS guidelines, what other interventions are recommended?

Answer 7

• Two person ventilations, due to increased airway resistance
• Decompress suspected pneumothoraxes and consider critical care support to perform
  a thoracostomy
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