By Dr Ananya Mandal, MD
Cardiac arrest prevention is important and should be attempted by all individuals who are at risk of having cardiac arrest. Recommendations for cardiac arrest prevention are laid out in the European Resuscitation Council Guidelines 2010.
The guidelines include updates based on those made in the National Institute for Health and Clinical Excellence guidelines and the joint statement from the British Medical Association and the Royal College of Nursing.
Prevention of an out-of-hospital arrest
One of the first steps in preventing a sudden cardiac death (SCD) due to cardiac arrest is recognising cardiac chest pain. In most victims, there is a positive history of cardiac disease as well as warning signs such as chest pain during the hour before arrest. Recognizing cardiac chest pain and rapidly contacting the emergency services can prevent full blown cardiac arrest and reduce the risk of SCD.
Most patients who have coronary artery disease or cardiomyopathy are at a high risk of cardiac arrest and SCD. SCD can also be caused by genetic heart conditions such as the long and short QT syndromes and Brugada syndrome.
Other warning symptoms, aside from chest pain, that precede a cardiac arrest include palpitation, pressure and tightness in the chest, pain or discomfort in one or both arms or the back, the neck, or the jaw, light-headedness, shortness of breath, sudden nausea, vomiting and hot or cold flushes.
Prevention of in-hospital cardiac arrest
The survival rates of in-hospital cardiac arrest are as low as 20% in most set-ups.
Prevention of these arrests involves improving factors such as staff education, the monitoring of patients, recognition of patient deterioration and management of impending arrest.
Adults with an in-hospital cardiac arrest should be monitored for ventricular fibrillation and defibrillated immediately.
Deteriorating patients should be identified. This includes patients with failing respiratory, cardiovascular, and nervous systems who may have an abnormal heart rate, breathing rate or blood pressure reading that could be an early sign of deterioration.
Cardiopulmonary resuscitation should be attempted even when the underlying condition and general health of the patient makes success unlikely.
Critically ill patients or those at risk of clinical deterioration should be placed in areas where the level of care is higher such as the intensive care unit.
Critically ill patients need continued monitoring of their vital signs such as their pulse, blood pressure, respiratory rate, consciousness level, temperature and blood oxygen.
The hospital needs to have a policy that clearly states responses to deteriorating patients need to be timely and appropriate.
All staff should be trained in the recognition, monitoring, and management of critically ill patients in cardiac arrest.
Reviewed by Sally Robertson, BSc