|Synonyms||cardiopulmonary arrest, circulatory arrest, sudden cardiac arrest (SCA), sudden cardiac death (SCD)|
|CPR being administered during a simulation of cardiac arrest.|
|Classification and external resources|
Cardiac arrest is a sudden stop in effective blood flow due to the failure of the heart to contract effectively. Symptoms include loss of consciousness and abnormal or absent breathing. Some people may have chest pain, shortness of breath, or nausea before this occurs. If not treated within minutes, death usually occurs.
The most common cause of cardiac arrest is coronary artery disease. Less common causes include major blood loss, lack of oxygen, very low potassium, heart failure, and intense physical exercise. A number of inherited disorders may also increase the risk including long QT syndrome. The initial heart rhythm is most often ventricular fibrillation. The diagnosis is confirmed by finding no pulse. While a cardiac arrest may be caused by heart attack or heart failure these are not the same.
Prevention includes not smoking, physical activity, and maintaining a healthy weight. Treatment for cardiac arrest is immediate cardiopulmonary resuscitation (CPR) and, if a shockable rhythm is present, defibrillation. Among those who survive targeted temperature management may improve outcomes. An implantable cardiac defibrillator may be placed to reduce the chance of death from recurrence.
In the United States, cardiac arrest outside of hospital occurs in about 13 per 10,000 people per year (326,000 cases). In hospital cardiac arrest occurs in an additional 209,000 Cardiac arrest becomes more common with age. It affects males more often than females. The percentage of people who survive with treatment is about 8%. Many who survive have significant disability. Many U.S. television shows, however, have portrayed unrealistically high survival rates of 67%.
- 1 Signs and symptoms
- 2 Causes
- 3 Mechanism
- 4 Diagnosis
- 5 Prevention
- 6 Management
- 7 Prognosis
- 8 Epidemiology
- 9 Names
- 10 References
- 11 External links
Signs and symptoms
Cardiac arrest is sometimes preceded by certain symptoms such as fainting, fatigue, blackouts, dizziness, chest pain, shortness of breath, weakness, and vomiting. The arrest may also occur with no warning.
When the arrest occurs, the most obvious sign of its occurrence will be the lack of a palpable pulse in the person experiencing it (since the heart has ceased to contract, the usual indications of its contraction such as a pulse will no longer be detectable). Certain types of prompt intervention can often reverse a cardiac arrest, but without such intervention the event will almost always lead to death. In certain cases, it is an expected outcome of a serious illness where death is expected.
Also, as a result of inadequate cerebral perfusion, the patient will quickly become unconscious and will have stopped breathing. The main diagnostic criterion to diagnose a cardiac arrest (as opposed to respiratory arrest which shares many of the same features) is lack of circulation; however, there are a number of ways of determining this. Near-death experiences are reported by 10–20% of people who survived cardiac arrest.
Coronary artery disease is the leading cause of sudden cardiac arrest. Many other cardiac and non-cardiac conditions also increase one's risk.
Coronary artery disease often results in coronary ischemia and ventricular fibrillation (v-fib). Cases have shown that the most common finding at postmortem examination of SCD is chronic high-grade stenosis of at least one segment of a major coronary artery, the arteries that supply the heart muscle with its blood supply. Left ventricular hypertrophy is thought to be the leading cause of sudden cardiac death in the adult population. This is most commonly the result of longstanding high blood pressure which has caused secondary damage to the wall of the main pumping chamber of the heart, the left ventricle.
Although the most frequent cause of sudden cardiac death is ventricular fibrillation, other causes include the following:
- Coronary heart disease
- Physical stress
- Inherited disorders
- Enlarged heart due to increased blood pressure
- Commotio cordis
Coronary artery disease
Approximately 60–70% of SCD is related to coronary artery disease, also known as ischemic heart disease. Among adults, it is the predominant cause of arrest, with 30% of people at autopsy showing signs of recent myocardial infarction.
Non-ischemic heart disease
A number of non-ischemic cardiac abnormalities can increase the risk of SCD, including cardiomyopathy, cardiac rhythm disturbances, myocarditis, hypertensive heart disease, and congestive heart failure.
In a group of military recruits aged 18–35, cardiac anomalies accounted for 51% of cases of SCD, while in 35% of cases the cause remained unknown. Underlying pathology included coronary artery abnormalities (61%), myocarditis (20%), and hypertrophic cardiomyopathy (13%). Congestive heart failure increases the risk of SCD fivefold.
Many additional conduction abnormalities exist that place one at higher risk for cardiac arrest. For instance, long QT syndrome, a condition often mentioned in young people's deaths, occurs in one of every 5000 to 7000 newborns and is estimated to be responsible for 3000 deaths each year compared to the approximately 300,000 cardiac arrests seen by emergency services. These conditions are a fraction of the overall deaths related to cardiac arrest, but represent conditions which may be detected prior to arrest and may be treatable.
About 35% of SCDs are not caused by a heart condition. The most common non-cardiac causes are trauma, bleeding (such as gastrointestinal bleeding, aortic rupture, or intracranial hemorrhage), overdose, drowning and pulmonary embolism. Cardiac arrest can also be caused by poisoning (for example, by the stings of certain jellyfish).
The risk factors for SCD are similar to those of coronary artery disease and include smoking, lack of physical exercise, obesity, and diabetes, as well as family history. A prior episode of sudden cardiac arrest also increases the risk of future episodes.
Mnemonic for causes
- Hypovolemia - A lack of blood volume
- Hypoxia - A lack of oxygen
- Hydrogen ions (Acidosis) - An abnormal pH in the body
- Hyperkalemia or Hypokalemia - Both excess and inadequate potassium can be life-threatening.
- Hypothermia - A low core body temperature
- Hypoglycemia or Hyperglycemia - Low or high blood glucose
- Tablets or Toxins
- Cardiac Tamponade - Fluid building around the heart
- Tension pneumothorax - A collapsed lung
- Thrombosis (Myocardial infarction) - Heart attack
- Thromboembolism (Pulmonary embolism) - A blood clot in the lung
- Traumatic cardiac arrest
The mechanism of death in the majority of people dying of sudden cardiac death is ventricular fibrillation. Structural changes in the diseased heart as a result of inherited factors (mutations in ion-channel coding genes for example) cannot explain the suddenness of SCD. Also, sudden cardiac death could be the consequence of electric-mechanical disjunction and bradyarrhythmias.
Cardiac arrest is synonymous with clinical death.
A cardiac arrest is usually diagnosed clinically by the absence of a pulse. In many cases lack of carotid pulse is the gold standard for diagnosing cardiac arrest, but lack of a pulse (particularly in the peripheral pulses) may result from other conditions (e.g. shock), or simply an error on the part of the rescuer. Studies have shown that rescuers often make a mistake when checking the carotid pulse in an emergency, whether they are healthcare professionals or lay persons.
Owing to the inaccuracy in this method of diagnosis, some bodies such as the European Resuscitation Council (ERC) have de-emphasised its importance. The Resuscitation Council (UK), in line with the ERC's recommendations and those of the American Heart Association, have suggested that the technique should be used only by healthcare professionals with specific training and expertise, and even then that it should be viewed in conjunction with other indicators such as agonal respiration.
Various other methods for detecting circulation have been proposed. Guidelines following the 2000 International Liaison Committee on Resuscitation (ILCOR) recommendations were for rescuers to look for "signs of circulation", but not specifically the pulse. These signs included coughing, gasping, colour, twitching and movement. However, in face of evidence that these guidelines were ineffective, the current recommendation of ILCOR is that cardiac arrest should be diagnosed in all casualties who are unconscious and not breathing normally.
Clinicians classify cardiac arrest into "shockable" versus "non–shockable", as determined by the ECG rhythm. This refers to whether a particular class of cardiac dysrhythmia is treatable using defibrillation. The two "shockable" rhythms are ventricular fibrillation and pulseless ventricular tachycardia while the two "non–shockable" rhythms are asystole and pulseless electrical activity.
With positive outcomes following cardiac arrest unlikely, an effort has been spent in finding effective strategies to prevent cardiac arrest. With the prime causes of cardiac arrest being ischemic heart disease, efforts to promote a healthy diet, exercise, and smoking cessation are important. For people at risk of heart disease, measures such as blood pressure control, cholesterol lowering, and other medico-therapeutic interventions are used. A Cochrane review published in 2016 found moderate-quality evidence to show that blood pressure-lowering drugs do not appear to reduce sudden cardiac death.
In medical parlance, cardiac arrest is referred to as a "code" or a "crash". This typically refers to "code blue" on the hospital emergency codes. A dramatic drop in vital sign measurements is referred to as "coding" or "crashing", though coding is usually used when it results in cardiac arrest, while crashing might not. Treatment for cardiac arrest is sometimes referred to as "calling a code".
People in general wards often deteriorate for several hours or even days before a cardiac arrest occurs. This has been attributed to a lack of knowledge and skill amongst ward-based staff, in particular a failure to carry out measurement of the respiratory rate, which is often the major predictor of a deterioration and can often change up to 48 hours prior to a cardiac arrest. In response to this, many hospitals now have increased training for ward-based staff. A number of "early warning" systems also exist which aim to quantify the risk which patients are at of deterioration based on their vital signs and thus provide a guide to staff. In addition, specialist staff are being utilised more effectively in order to augment the work already being done at ward level. These include:
- Crash teams (or code teams) - These are designated staff members with particular expertise in resuscitation who are called to the scene of all arrests within the hospital. This usually involves a specialized cart of equipment (including defibrillator) and drugs called a "crash cart" or "crash trolley".
- Medical emergency teams - These teams respond to all emergencies, with the aim of treating the people in the acute phase of their illness in order to prevent a cardiac arrest. These teams have been found to decrease the rates of in hospital cardiac arrest and improve survival.
- Critical care outreach - As well as providing the services of the other two types of team, these teams are also responsible for educating non-specialist staff. In addition, they help to facilitate transfers between intensive care/high dependency units and the general hospital wards. This is particularly important, as many studies have shown that a significant percentage of patients discharged from critical care environments quickly deteriorate and are re-admitted; the outreach team offers support to ward staff to prevent this from happening.
In some medical facilities, the resuscitation team may purposely respond slowly to a person in cardiac arrest, a practice known as "slow code", or may fake the response altogether for the sake of the person's family, a practice known as "show code". This is generally done for people for whom performing CPR will have no medical benefit. Such practices are ethically controversial, and are banned in some jurisdictions.
Implantable cardioverter defibrillators
A technologically based intervention to prevent further cardiac arrest episodes is the use of an implantable cardioverter-defibrillator (ICD). This device is implanted in the patient and acts as an instant defibrillator in the event of arrhythmia. Note that standalone ICDs do not have any pacemaker functions, but they can be combined with a pacemaker, and modern versions also have advanced features such as anti-tachycardic pacing as well as synchronized cardioversion. A recent study by Birnie et al. at the University of Ottawa Heart Institute has demonstrated that ICDs are underused in both the United States and Canada. An accompanying editorial by Simpson explores some of the economic, geographic, social and political reasons for this. Patients who are most likely to benefit from the placement of an ICD are those with severe ischemic cardiomyopathy (with systolic ejection fractions less than 30%) as demonstrated by the MADIT-II trial.
Marine-derived omega-3 polyunsaturated fatty acids (PUFAs) has been promoted for the prevention of sudden cardiac death due to its postulated ability to lower triglyceride levels, prevent arrhythmias, decrease platelet aggregation, and lower blood pressure. However, according to a recent systematic review, omega-3 PUFA supplementation are not been associated with a lower risk of sudden cardiac death.
Sudden cardiac arrest may be treated via attempts at resuscitation. This is usually carried out based upon basic life support (BLS)/advanced cardiac life support (ACLS), pediatric advanced life support (PALS) or neonatal resuscitation program (NRP) guidelines.
Cardiopulmonary resuscitation (CPR) is an important part of the management of cardiac arrest. It is recommended that it be started as soon as possible and interrupted as little as possible. The component of CPR that seems to make the greatest difference in most cases is the chest compressions. Correctly performed bystander CPR has been shown to increase survival; however, it is performed in less than 30% of out of hospital arrests as of 2007. If high-quality CPR has not resulted in return of spontaneous circulation and the person's heart rhythm is in asystole, discontinuing CPR and pronouncing the person's death is reasonable after 20 minutes. Exceptions to this include those with hypothermia or who have drowned. Longer durations of CPR may be reasonable in those who have cardiac arrest while in hospital. Bystander CPR, by the lay public, before the arrival of EMS also improves outcomes.
Either a bag valve mask or an advanced airway may be used to help with breathing. High levels of oxygen are generally given during CPR. Tracheal intubation has not been found to improve survival rates in cardiac arrest and in the prehospital environment may worsen it.
CPR which involves only chest compressions results in the same outcomes as standard CPR for those who have gone into cardiac arrest due to heart issues. Mechanical chest compressions (as performed by a machine) are no better than chest compressions performed by hand. It is unclear if a few minutes of CPR before defibrillation results in different outcomes than immediate defibrillation. If cardiac arrest occurs after 20 weeks of pregnancy someone should pull or push the uterus to the left during CPR. If a pulse has not returned by four minutes emergency Cesarean section is recommended.
In addition, there is increasing use of public access defibrillation. This involves placing automated external defibrillators in public places, and training staff in these areas how to use them. This allows defibrillation to take place prior to the arrival of emergency services, and has been shown to lead to increased chances of survival. Some defibrillators even provide feedback on the quality of CPR compressions, encouraging the lay rescuer to press the patient's chest hard enough to circulate blood. In addition, it has been shown that those who have arrests in remote locations have worse outcomes following cardiac arrest.
Medications, while included in guidelines, have not been shown to improve survival to hospital discharge following out-of-hospital cardiac arrest. This includes the use of epinephrine, atropine, lidocaine, and amiodarone. Epinephrine is generally recommended every five minutes. Vasopressin overall does not improve or worsen outcomes compared to epinephrine.
Epinephrine does appear to improve short-term outcomes such as return of spontaneous circulation. Some of the lack of long-term benefit may be related to delays in epinephrine use. While evidence does not support its use in children guidelines state its use is reasonable. Lidocaine and amiodarone are also deemed reasonable in children with cardiac arrest who have a shockable rhythm. The general use of sodium bicarbonate or calcium is not recommended.
The 2010 guidelines from the American Heart Association no longer contain the recommendation for using atropine in pulseless electrical activity and asystole due to the lack of evidence for its use. Neither lidocaine nor amiodarone, in those who continue in ventricular tachycardia or ventricular fibrillation despite defibrillation, improves survival to hospital discharge but both equally improve survival to hospital admission.
Thrombolytics when used generally may cause harm but may be of benefit in those with a confirmed pulmonary embolism as the cause of arrest. Evidence for use of naloxone in those with cardiac arrest due to opioids is unclear but it may still be used. In those with cardiac arrest due to local anesthetic lipid emulsion may be used.
Targeted temperature management
Cooling adults after cardiac arrest who have a return of spontaneous circulation (ROSC) but no return of consciousness improves outcomes. This procedure is called targeted temperature management (previously known as therapeutic hypothermia). People are typically cooled for a 24-hour period, with a target temperature of 32–36 °C (90–97 °F). Death rates in the hypothermia group are 35% lower than in those with no temperature management.[needs update] Complications are generally no greater in those who receive this therapy.
Earlier versus later cooling may result in better outcomes. A trial that cooled in the ambulance, however, found no difference compared to starting cooling in-hospital. A registry database found poor neurological outcome increased by 8% with each five-minute delay in initiating TH and by 17% for every 30-minute delay in time to target temperature. In children it is unclear if cooling is beneficial however fever should be prevented.
Do not resuscitate
Some people choose to avoid aggressive measures at the end of life. A do not resuscitate order (DNR) in the form of an advance health care directive makes it clear that in the event of cardiac arrest, the person does not wish to receive cardiopulmonary resuscitation. Other directives may be made to stipulate the desire for intubation in the event of respiratory failure or, if comfort measures are all that are desired, by stipulating that healthcare providers should "allow natural death".
Chain of survival
Several organizations promote the idea of a chain of survival. The chain consists of the following "links":
- Early recognition - If possible, recognition of illness before the patient develops a cardiac arrest will allow the rescuer to prevent its occurrence. Early recognition that a cardiac arrest has occurred is key to survival - for every minute a patient stays in cardiac arrest, their chances of survival drop by roughly 10%.
- Early CPR - improves the flow of blood and of oxygen to vital organs, an essential component of treating a cardiac arrest. In particular, by keeping the brain supplied with oxygenated blood, chances of neurological damage are decreased.
- Early defibrillation - is effective for the management of ventricular fibrillation and pulseless ventricular tachycardia
- Early advanced care
- Early post-resuscitation care which may include percutaneous coronary intervention
If one or more links in the chain are missing or delayed, then the chances of survival drop significantly.
These protocols are often initiated by a code blue, which usually denotes impending or acute onset of cardiac arrest or respiratory failure, although in practice, code blue is often called in less life-threatening situations that require immediate attention from a physician.
Resuscitation with extracorporeal membrane oxygenation devices has been attempted with better results for in-hospital cardiac arrest (29% survival) than out-of-hospital cardiac arrest (4% survival) in populations selected to benefit most. Cardiac catheterization in those who have survived an out-of-hospital cardiac arrest appears to improve outcomes although high quality evidence is lacking. It is recommended that it is done as soon as possible in those who have had a cardiac arrest with ST elevation due to underlying heart problems.
The precordial thump may be considered in those with witnessed, monitored, unstable ventricular tachycardia (including pulseless VT) if a defibrillator is not immediately ready for use, but it should not delay CPR and shock delivery or be used in those with unwitnessed out of hospital arrest.
The overall chance of survival among those who have cardiac arrest outside of a hospital is 7.6%. Among children rates of survival is 3 to 16% in North America. For in hospital cardiac arrest survival to discharge is around 22% with many having a good neurological outcome.
Prognosis is typically assessed 72 hours or more after cardiac arrest. Rates of survival are better in those who someone saw collapse, got bystander CPR, or had either ventricular tachycardia or ventricular fibrillation when assessed. Survival among those with Vfib or Vtach is 15 to 23%. Women are more likely to survive cardiac arrest and leave hospital than men.
A 1997 review into outcomes following in-hospital cardiac arrest found a survival to discharge of 14% although the range between different studies was 0-28%. In those over the age of 70 who have a cardiac arrest while in hospital, survival to hospital discharge is less than 20%. How well these individuals are able to manage after leaving hospital is not clear.
A study of survival rates from out-of-hospital cardiac arrest found that 14.6% of those who had received resuscitation by ambulance staff survived as far as admission to hospital. Of these, 59% died during admission, half of these within the first 24 hours, while 46% survived until discharge from hospital. This reflects an overall survival following cardiac arrest of 6.8%. Of these 89% had normal brain function or mild neurological disability, 8.5% had moderate impairment, and 2% had major neurological disability. Of those who were discharged from hospital, 70% were still alive four years later.
Based on death certificates, sudden cardiac death accounts for about 15% of all death in Western countries. In the United States 326,000 cases of out of hospital and 209,000 cases of in hospital cardiac arrest occur among adults a year. The lifetime risk is three times greater in men (12.3%) than women (4.2%) based on analysis of the Framingham Heart Study. However this gender difference disappeared beyond 85 years of age.
In many publications the stated or implicit meaning of "sudden cardiac death" is sudden death from cardiac causes. However, sometimes physicians call cardiac arrest "sudden cardiac death" even if the person survives. Thus one can hear mentions of "prior episodes of sudden cardiac death" in a living person, which sounds odd as judged by the sense of the term that involves death but is understood as invoking the other sense.
- Field, John M. (2009). The Textbook of Emergency Cardiovascular Care and CPR. Lippincott Williams & Wilkins. p. 11. ISBN 9780781788991.
- "What Is Sudden Cardiac Arrest?". NHLBI. June 22, 2016. Retrieved 16 August 2016.
- "What Are the Signs and Symptoms of Sudden Cardiac Arrest?". NHLBI. June 22, 2016. Retrieved 16 August 2016.
- "What Causes Sudden Cardiac Arrest?". NHLBI. June 22, 2016. Retrieved 16 August 2016.
- "How Can Death Due to Sudden Cardiac Arrest Be Prevented?". NHLBI. June 22, 2016. Retrieved 16 August 2016.
- "How Is Sudden Cardiac Arrest Treated?". NHLBI. June 22, 2016. Retrieved 16 August 2016.
- Schenone, AL; Cohen, A; Patarroyo, G; Harper, L; Wang, X; Shishehbor, MH; Menon, V; Duggal, A (10 August 2016). "Therapeutic hypothermia after cardiac arrest: a systematic review/meta-analysis exploring the impact of expanded criteria and targeted temperature.". Resuscitation. 108: 102–110. doi:10.1016/j.resuscitation.2016.07.238. PMID 27521472.
- Kronick, SL; Kurz, MC; Lin, S; Edelson, DP; Berg, RA; Billi, JE; Cabanas, JG; Cone, DC; Diercks, DB; Foster, JJ; Meeks, RA; Travers, AH; Welsford, M (3 November 2015). "Part 4: Systems of Care and Continuous Quality Improvement: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.". Circulation. 132 (18 Suppl 2): S397–413. doi:10.1161/cir.0000000000000258. PMID 26472992.
- "Who Is at Risk for Sudden Cardiac Arrest?". NHLBI. June 22, 2016. Retrieved 16 August 2016.
- Adams, James G. (2012). Emergency Medicine: Clinical Essentials (Expert Consult -- Online). Elsevier Health Sciences. p. 1771. ISBN 1455733946.
- "What Are the Signs and Symptoms of Sudden Cardiac Arrest?". National Heart, Lung and Blood Institute. 1 April 2011. Retrieved 2015-06-21.
- Jameson, J. N. St C.; Dennis L. Kasper; Harrison, Tinsley Randolph; Braunwald, Eugene; Fauci, Anthony S.; Hauser, Stephen L; Longo, Dan L. (2005). Harrison's principles of internal medicine. New York: McGraw-Hill Medical Publishing Division. ISBN 0-07-140235-7.
- "Mount Sinai - Cardiac arrest".
- Parnia, S; Spearpoint, K; Fenwick, PB (August 2007). "Near death experiences, cognitive function and psychological outcomes of surviving cardiac arrest.". Resuscitation. 74 (2): 215–21. doi:10.1016/j.resuscitation.2007.01.020. PMID 17416449.
- Koplan, Bruce A.; Stevenson, William G. (2009). "Ventricular Tachycardia and Sudden Cardiac Death". Mayo Clinic Proceedings. 84 (3): 289–297. doi:10.4065/84.3.289. ISSN 0025-6196. PMC . PMID 19252119.
- Fuster, Valentin; Topol, Eric J.; Nabel, Elizabeth G. (2005). Atherothrombosis and Coronary Artery Disease. Lippincott Williams & Wilkins. ISBN 9780781735834.
- Stevens, Steven M.; Reinier, Kyndaron; Chugh, Sumeet S. (2013). "Increased Left Ventricular Mass as a Predictor of Sudden Cardiac Death Is it Time to Put it to The Test?". Circulation: Arrhythmia and Electrophysiology. 6 (1): 212–217. doi:10.1161/CIRCEP.112.974931. ISSN 1941-3149. PMID 23424223.
- Katholi RE, Couri DM (2011). "Left Ventricular Hypertrophy: Major Risk Factor in Patients with Hypertension: Update and Practical Clinical Applications". Int J Hypertens.: 495349. doi:10.4061/2011/495349. PMC . PMID 21755036.
- "What Causes Sudden Cardiac Arrest?". National Heart, Lung and Blood Institute. 1 April 2011. Retrieved 2015-06-21.
- Zheng ZJ, Croft JB, Giles WH, Mensah GA (October 2001). "Sudden cardiac death in the United States, 1989 to 1998". Circulation. 104 (18): 2158–63. doi:10.1161/hc4301.098254. PMID 11684624.
- Centers for Disease Control and Prevention (CDC) (February 2002). "State-specific mortality from sudden cardiac death--United States, 1999". MMWR Morb. Mortal. Wkly. Rep. 51 (6): 123–6. PMID 11898927.
- Eisenberg MS, Mengert TJ (April 2001). "Cardiac resuscitation". N. Engl. J. Med. 344 (17): 1304–13. doi:10.1056/NEJM200104263441707. PMID 11320390.
- Kannel WB, Wilson PW, D'Agostino RB, Cobb J (August 1998). "Sudden coronary death in women". Am. Heart J. 136 (2): 205–12. doi:10.1053/hj.1998.v136.90226. PMID 9704680.
- Eckart RE, Scoville SL, Campbell CL, et al. (December 2004). "Sudden death in young adults: a 25-year review of autopsies in military recruits". Annals of Internal Medicine. 141 (11): 829–34. doi:10.7326/0003-4819-141-11-200412070-00005. PMID 15583223.
- Sudden Cardiac Death
- Kuisma M, Alaspää A (July 1997). "Out-of-hospital cardiac arrests of non-cardiac origin. Epidemiology and outcome". Eur. Heart J. 18 (7): 1122–8. doi:10.1093/oxfordjournals.eurheartj.a015407. PMID 9243146.
- Friedlander Y, Siscovick DS, Weinmann S, et al. (January 1998). "Family history as a risk factor for primary cardiac arrest". Circulation. 97 (2): 155–60. doi:10.1161/01.cir.97.2.155. PMID 9445167.
- "Resuscitation Council (UK) Guidelines 2005".
- ECC Committee, Subcommittees and Task Forces of the American Heart Association (December 2005). "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 112 (24 Suppl): IV1–203. doi:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375.
- Rubart, Michael; Zipes, Douglas P. (2005). "Mechanisms of sudden cardiac death". Journal of Clinical Investigation. 115 (9): 2305–2315. doi:10.1172/JCI26381. ISSN 0021-9738. PMC . PMID 16138184.
- Bunch, T. Jared; Hohnloser, Stefan H.; Gersh, Bernard J. (2007). "Mechanisms of Sudden Cardiac Death in Myocardial Infarction Survivors Insights From the Randomized Trials of Implantable Cardioverter-Defibrillators". Circulation. 115 (18): 2451–2457. doi:10.1161/CIRCULATIONAHA.106.683235. ISSN 0009-7322. PMID 17485594.
- "Types of Arrhythmia". National Heart, Lung and Blood Institute. 1 April 2011. Retrieved 2015-06-21.
- Ochoa FJ, Ramalle-Gómara E, Carpintero JM, García A, Saralegui I (June 1998). "Competence of health professionals to check the carotid pulse". Resuscitation. 37 (3): 173–5. doi:10.1016/S0300-9572(98)00055-0. PMID 9715777.
- Bahr J, Klingler H, Panzer W, Rode H, Kettler D (August 1997). "Skills of lay people in checking the carotid pulse". Resuscitation. 35 (1): 23–6. doi:10.1016/S0300-9572(96)01092-1. PMID 9259056.
- British Red Cross; St Andrew's Ambulance Association; St John Ambulance (2006). First Aid Manual: The Authorised Manual of St. John Ambulance, St. Andrew's Ambulance Association, and the British Red Cross. Dorling Kindersley Publishers Ltd. ISBN 1-4053-1573-3.
- Jasmeet Soar, Gavin D. Perkins, Jerry Nolan., eds. (2012). ABC of resuscitation (6th ed.). Chichester, West Sussex: Wiley-Blackwell. p. 43. ISBN 9781118474853.
- Taverny, G; Mimouni, Y; LeDigarcher, A; Chevalier, P; Thijs, L; Wright, JM; Gueyffier, F (10 March 2016). "Antihypertensive pharmacotherapy for prevention of sudden cardiac death in hypertensive individuals.". The Cochrane database of systematic reviews. 3: CD011745. doi:10.1002/14651858.CD011745.pub2. PMID 26961575. Retrieved 19 March 2016.
- Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman K (September 2004). "A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom--the ACADEMIA study". Resuscitation. 62 (3): 275–82. doi:10.1016/j.resuscitation.2004.05.016. PMID 15325446.
- "Slow Codes, Show Codes and Death". New York Times. New York Times Company. 22 August 1987. Retrieved 2013-04-06.
- "Decision-making for the End of Life". Physician Advisory Service. College of Physicians and Surgeons of Ontario. May 2006. Retrieved 2013-04-06.
- DePalma, Judith A.; Miller, Scott; Ozanich, Evelyn; Yancich, Lynne M. (November 1999). "Slow" Code: Perspectives of a Physician and Critical Care Nurse. Critical Care Nursing Quarterly. 22. Lippincott Williams and Wilkins. pp. 89–99. ISSN 1550-5111.
- Birnie, David H; Sambell, Christie; Johansen, Helen; Williams, Katherine; Lemery, Robert; Green, Martin S; Gollob, Michael H; Lee, Douglas S; Tang, Anthony SL (July 2007). "Use of implantable cardioverter defibrillators in Canadian and IS survivors of out-of-hospital cardiac arrest". Canadian Medical Association Journal. 177 (1): 41–6. doi:10.1503/cmaj.060730. PMC . PMID 17606938. Retrieved 2007-07-29.
- Simpson CS (July 2007). "Implantable cardioverter defibrillators work--so why aren't we using them?". CMAJ. 177 (1): 49–51. doi:10.1503/cmaj.070470. PMC . PMID 17606939.
- Moss AJ, Brown MW, Cannom DS, et al. (October 2005). "Multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT): design and clinical protocol". Ann Noninvasive Electrocardiol. 10 (4 Suppl): 34–43. doi:10.1111/j.1542-474X.2005.00073.x. PMID 16274414.
- Neil K. Kaneshiro (2 August 2011). "Omega-3 fatty acids". MedlinePlus Medical Encyclopedia. Retrieved 2015-06-21.
- Evangelos C. Rizos; Evangelia E. Ntzani; Eftychia Bika; Michael S. Kostapanos; Moses S. Elisaf (September 2012). "Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events A Systematic Review and Meta-analysis". JAMA. 308 (10): 1024–1033. doi:10.1001/2012.jama.11374. PMID 22968891.
- American Heart, Association (May 2006). "2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric advanced life support". Pediatrics. 117 (5): e1005–28. doi:10.1542/peds.2006-0346. PMID 16651281.
- Mutchner L (January 2007). "The ABCs of CPR--again". Am J Nurs. 107 (1): 60–9; quiz 69–70. doi:10.1097/00000446-200701000-00024. PMID 17200636.
- Resuscitation Council (UK). "Pre-hospital cardiac arrest" (PDF). www.resus.org.uk. p. 41. Retrieved 3 September 2014.
- Resuscitation Council (UK) (5 September 2012). "Comments on the duration of CPR following the publication of 'Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study' Goldberger ZD et al. Lancet.". Retrieved 3 September 2014.
- Neumar, RW; Shuster, M; Callaway, CW; Gent, LM; Atkins, DL; Bhanji, F; Brooks, SC; de Caen, AR; Donnino, MW; Ferrer, JM; Kleinman, ME; Kronick, SL; Lavonas, EJ; Link, MS; Mancini, ME; Morrison, LJ; O'Connor, RE; Samson, RA; Schexnayder, SM; Singletary, EM; Sinz, EH; Travers, AH; Wyckoff, MH; Hazinski, MF (3 November 2015). "Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.". Circulation. 132 (18 Suppl 2): S315–67. doi:10.1161/cir.0000000000000252. PMID 26472989.
- Studnek JR, Thestrup L, Vandeventer S, et al. (September 2010). "The association between prehospital endotracheal intubation attempts and survival to hospital discharge among out-of-hospital cardiac arrest patients". Acad Emerg Med. 17 (9): 918–25. doi:10.1111/j.1553-2712.2010.00827.x. PMID 20836771.
- Yao, L; Wang, P; Zhou, L; Chen, M; Liu, Y; Wei, X; Huang, Z (Jun 2014). "Compression-only cardiopulmonary resuscitation vs standard cardiopulmonary resuscitation: an updated meta-analysis of observational studies.". The American journal of emergency medicine. 32 (6): 517–23. doi:10.1016/j.ajem.2014.01.055. PMID 24661781.
- Huang, Y; He, Q; Yang, LJ; Liu, GJ; Jones, A (Sep 12, 2014). "Cardiopulmonary resuscitation (CPR) plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest.". The Cochrane database of systematic reviews. 9: CD009803. doi:10.1002/14651858.CD009803.pub2. PMID 25212112.
- Lavonas, EJ; Drennan, IR; Gabrielli, A; Heffner, AC; Hoyte, CO; Orkin, AM; Sawyer, KN; Donnino, MW (3 November 2015). "Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.". Circulation. 132 (18 Suppl 2): S501–18. doi:10.1161/cir.0000000000000264. PMID 26472998.
- de Caen, AR; Berg, MD; Chameides, L; Gooden, CK; Hickey, RW; Scott, HF; Sutton, RM; Tijssen, JA; Topjian, A; van der Jagt, ÉW; Schexnayder, SM; Samson, RA (3 November 2015). "Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.". Circulation. 132 (18 Suppl 2): S526–42. doi:10.1161/cir.0000000000000266. PMID 26473000.
- Zoll AED Plus
- Lyon R.M; Cobbe S.M.; Bradley J.M.; Grubb N.R.; et al. (2004). "Surviving out of hospital cardiac arrest at home: a postcode lottery?". Emergency Medical Journal. 21: 619–624. doi:10.1136/emj.2003.010363.
- Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, Wik L (November 2009). "Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial". JAMA. 302 (20): 2222–9. doi:10.1001/jama.2009.1729. PMID 19934423.
- Lin, S; Callaway, CW; Shah, PS; Wagner, JD; Beyene, J; Ziegler, CP; Morrison, LJ (Mar 15, 2014). "Adrenaline for out-of-hospital cardiac arrest resuscitation: A systematic review and meta-analysis of randomized controlled trials.". Resuscitation. 85 (6): 732–40. doi:10.1016/j.resuscitation.2014.03.008. PMID 24642404.
- Laina, A; Karlis, G; Liakos, A; Georgiopoulos, G; Oikonomou, D; Kouskouni, E; Chalkias, A; Xanthos, T (9 July 2016). "Amiodarone and cardiac arrest: Systematic review and meta-analysis.". International journal of cardiology. 221: 780–788. doi:10.1016/j.ijcard.2016.07.138. PMID 27434349.
- Morley, PT (June 2011). "Drugs during cardiopulmonary resuscitation.". Current Opinion in Critical Care. 17 (3): 214–8. doi:10.1097/MCC.0b013e3283467ee0. PMID 21499094.
- Attaran, RR; Ewy, GA (July 2010). "Epinephrine in resuscitation: curse or cure?". Future cardiology. 6 (4): 473–82. doi:10.2217/fca.10.24. PMID 20608820.
- Velissaris, D; Karamouzos, V; Pierrakos, C; Koniari, I; Apostolopoulou, C; Karanikolas, M (April 2016). "Use of Sodium Bicarbonate in Cardiac Arrest: Current Guidelines and Literature Review.". Journal of clinical medicine research. 8 (4): 277–83. doi:10.14740/jocmr2456w. PMC . PMID 26985247.
- Neumar, RW; Otto, CW; Link, MS; Kronick, SL; Shuster, M; Callaway, CW; Kudenchuk, PJ; Ornato, JP; McNally, B; Silvers, SM; Passman, RS; White, RD; Hess, EP; Tang, W; Davis, D; Sinz, E; Morrison, LJ (Nov 2, 2010). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.". Circulation. 122 (18 Suppl 3): S729–67. doi:10.1161/CIRCULATIONAHA.110.970988. PMID 20956224.
- Sanfilippo, F; Corredor, C; Santonocito, C; Panarello, G; Arcadipane, A; Ristagno, G; Pellis, T (October 2016). "Amiodarone or lidocaine for cardiac arrest: A systematic review and meta-analysis.". Resuscitation. 107: 31–7. doi:10.1016/j.resuscitation.2016.07.235. PMID 27496262.
- Perrott, J; Henneberry, RJ; Zed, PJ (December 2010). "Thrombolytics for cardiac arrest: case report and systematic review of controlled trials.". Annals of Pharmacotherapy. 44 (12): 2007–13. doi:10.1345/aph.1P364. PMID 21119096.
- Xiao, G; Guo, Q; Shu, M; Xie, X; Deng, J; Zhu, Y; Wan, C (February 2013). "Safety profile and outcome of mild therapeutic hypothermia in patients following cardiac arrest: systematic review and meta-analysis.". Emergency medicine journal : EMJ. 30 (2): 91–100. doi:10.1136/emermed-2012-201120. PMID 22660549.
- Nielsen, Niklas; Wetterslev, Jørn; Cronberg, Tobias; Erlinge, David; Gasche, Yvan; Hassager, Christian; Horn, Janneke; Hovdenes, Jan; Kjaergaard, Jesper; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wanscher, Michael; Wise, Matt P.; Åneman, Anders; Al-Subaie, Nawaf; Boesgaard, Søren; Bro-Jeppesen, John; Brunetti, Iole; Bugge, Jan Frederik; Hingston, Christopher D.; Juffermans, Nicole P.; Koopmans, Matty; Køber, Lars; Langørgen, Jørund; Lilja, Gisela; Møller, Jacob Eifer; Rundgren, Malin; Rylander, Christian; Smid, Ondrej; Werer, Christophe; Winkel, Per; Friberg, Hans (17 November 2013). "Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest". New England Journal of Medicine. 369 (23): 131117131833001. doi:10.1056/NEJMoa1310519. PMID 24237006.
- Arrich, J; Holzer, M; Havel, C; Müllner, M; Herkner, H (Sep 12, 2012). "Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation.". Cochrane database of systematic reviews (Online). 9: CD004128. doi:10.1002/14651858.CD004128.pub3. PMID 22972067.
- Stockmann, H; Krannich, A; Schroeder, T; Storm, C (November 2014). "Therapeutic temperature management after cardiac arrest and the risk of bleeding: Systematic review and meta-analysis.". Resuscitation. 85 (11): 1494–1503. doi:10.1016/j.resuscitation.2014.07.018. PMID 25132475.
- Dell'anna, AM; Scolletta, S; Donadello, K; Taccone, FS (June 2014). "Early neuroprotection after cardiac arrest.". Current opinion in critical care. 20 (3): 250–8. doi:10.1097/mcc.0000000000000086. PMID 24717694.
- Sendelbach, S; Hearst, MO; Johnson, PJ; Unger, BT; Mooney, MR (July 2012). "Effects of variation in temperature management on cerebral performance category scores in patients who received therapeutic hypothermia post cardiac arrest.". Resuscitation. 83 (7): 829–34. doi:10.1016/j.resuscitation.2011.12.026. PMID 22230942.
- Loertscher, L; Reed, DA; Bannon, MP; Mueller, PS (January 2010). "Cardiopulmonary resuscitation and do-not-resuscitate orders: a guide for clinicians". The American Journal of Medicine. 123 (1): 4–9. doi:10.1016/j.amjmed.2009.05.029. PMID 20102982.
- Knox, C; Vereb, JA (December 2005). "Allow natural death: a more humane approach to discussing end-of-life directives". Journal of Emergency Nursing. 31 (6): 560–1. doi:10.1016/j.jen.2005.06.020. PMID 16308044.
- Millin, MG; Comer, AC; Nable, JV; Johnston, PV; Lawner, BJ; Woltman, N; Levy, MJ; Seaman, KG; Hirshon, JM (15 September 2016). "Patients without ST elevation after return of spontaneous circulation may benefit from emergent percutaneous intervention: A systematic review and meta-analysis.". Resuscitation. 108: 54–60. doi:10.1016/j.resuscitation.2016.09.004. PMID 27640933.
- Lehot, JJ; Long-Him-Nam, N; Bastien, O (December 2011). "[Extracorporeal life support for treating cardiac arrest].". Bulletin de l'Academie nationale de medecine. 195 (9): 2025–33; discussion 2033–6. PMID 22930866.
- Camuglia, AC.; Randhawa, VK.; Lavi, S.; Walters, DL. (Sep 2014). "Cardiac catheterization is associated with superior outcomes for survivors of out of hospital cardiac arrest: Review and meta-analysis.". Resuscitation. 85: 1533–1540. doi:10.1016/j.resuscitation.2014.08.025. PMID 25195073.
- Cave, DM; Gazmuri, RJ; Otto, CW; Nadkarni, VM; Cheng, A; Brooks, SC; Daya, M; Sutton, RM; Branson, R; Hazinski, MF (2010-11-02). "Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.". Circulation. 122 (18 Suppl 3): S720–8. doi:10.1161/CIRCULATIONAHA.110.970970. PMC . PMID 20956223.
- Sasson, C; Rogers, MA; Dahl, J; Kellermann, AL (January 2010). "Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.". Circulation. Cardiovascular quality and outcomes. 3 (1): 63–81. doi:10.1161/circoutcomes.109.889576. PMID 20123673.
- Bougouin, W; Mustafic, H; Marijon, E; Murad, MH; Dumas, F; Barbouttis, A; Jabre, P; Beganton, F; Empana, JP; Celermajer, DS; Cariou, A; Jouven, X (September 2015). "Gender and survival after sudden cardiac arrest: A systematic review and meta-analysis.". Resuscitation. 94: 55–60. doi:10.1016/j.resuscitation.2015.06.018. PMID 26143159.
- Ballew KA (May 1997). "Cardiopulmonary resuscitation". BMJ. 314 (7092): 1462–5. doi:10.1136/bmj.314.7092.1462. PMC . PMID 9167565.
- van Gijn, MS; Frijns, D; van de Glind, EM; C van Munster, B; Hamaker, ME (Jul 2014). "The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review.". Age and ageing. 43 (4): 456–63. doi:10.1093/ageing/afu035. PMID 24760957.
- Cobbe SM, Dalziel K, Ford I, Marsden AK (June 1996). "Survival of 1476 patients initially resuscitated from out of hospital cardiac arrest". BMJ. 312 (7047): 1633–7. doi:10.1136/bmj.312.7047.1633. PMC . PMID 8664715.
- "Abstract 969: Lifetime Risk for Sudden Cardiac Death at Selected Index Ages and by Risk Factor Strata and Race: Cardiovascular Lifetime Risk Pooling Project -- Lloyd-Jones et al. 120 (10018): S416 -- Circulation".[dead link][dead link]
- Elsevier, Dorland's Illustrated Medical Dictionary, Elsevier.
- Porter, I; Vacek, J (2008), "Single ventricle with persistent truncus arteriosus as two rare entities in an adult patient: a case report", J Med Case Reports, 2: 184, doi:10.1186/1752-1947-2-184, PMC , PMID 18513397.