section name header

Introduction ⬇

In cardiac arrest, the heart is unable to pump and circulate blood to the body's organs and tissues. It may be caused by a dysrhythmia such as ventricular fibrillation, progressive bradycardia, or asystole. Cardiac arrest can also occur when electrical activity is present but there is ineffective cardiac contraction or circulating volume, which is called pulseless electrical activity (PEA). PEA can be caused by hypovolemia (e.g., hemorrhage), hypoxia, hypothermia, hyperkalemia, massive pulmonary embolism, myocardial infarction, or medication overdose. Rapid identification of these problems and prompt intervention can restore circulation in some patients.

Emergency Assessment and Management: Cardiopulmonary Resuscitation

  • On recognition of sudden cardiac arrest, the patient is checked for responsiveness and breathing.
  • The Emergency Response System (ERS; “Code Blue,” “Code 4,” or 911) is activated.
  • Cardiopulmonary resuscitation (CPR) is initiated immediately.
  • Cardiac rhythm is analyzed and defibrillation provided as soon as possible with automated external defibrillator (AED) or defibrillator.
  • Placement of an advanced airway such as an endotracheal (ET) tube may be performed during resuscitation to ensure a patent airway and adequate ventilation.
  • Medications are administered to reverse cardiopulmonary arrest according to Advanced Cardiac Life Support guidelines for advanced support interventions.
  • Follow-up monitoring is instituted once patient is resuscitated, including continuous electrocardiographic (ECG) monitoring, frequent blood pressure assessments until hemodynamic stability is attained, and identification and treatment of factors that precipitated the arrest, such as dysrhythmias or electrolyte or metabolic imbalances.
  • Patient is assessed after resuscitation and return of spontaneous circulation; patients who are comatose may benefit from therapeutic hypothermia protocols.

For more information, see Chapter 29 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Clinical Manifestations ⬆

In cardiac arrest, consciousness, pulse, and blood pressure are lost immediately. Ineffective respiratory gasping may occur. The pupils of the eyes begin dilating in less than a minute, and seizures may occur. Pallor and cyanosis are seen in the skin and mucous membranes. The risk of organ damage, irreversible brain damage, and death increases with every minute that circulation ceases. The interval varies with the age and underlying condition of the patient. During this period, the diagnosis of cardiac arrest must be made and measures must be taken immediately to restore circulation.