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Cardiopulmonary Resuscitation

Aka: Cardiopulmonary Resuscitation, ABC Management, Adult Resuscitation, Pediatric Resuscitation, Resuscitation, CPR, Cardiac Arrest

I. See Also

  1. Newborn Resuscitation
  2. Guidelines for Emergency Cardiovascular Care
  3. Pediatric Assessment Triangle
  4. Trauma Primary Survey
  5. Trauma Secondary Survey
  6. Induced Therapeutic Hypothermia
  7. Emergency Decision Cycle (OODA Loop, AAADA Model)
  8. Reversible Causes of Cardiopulmonary Arrest

II. Protocol

  1. ATLS is integrated with ACLS and PALS for the purposes of this reference
    1. Typically ACLS, ATLS, PALS are taught in isolation (outside CALS Course)
  2. ACLS guidelines 2010 focuses on Cardiac Compressions as the first line intervention
    1. Mnemonic is 'C-A-B' to emphasize compressions
      1. Chest Compressions are started within 10 seconds of recognition of arrest
        1. Health care providers start with a pulse check prior to compressions
        2. First-responders start compressions without a pulse check to minimize delays
      2. Compressions are hard (at least 2 inches or 5 cm deep in adults)
      3. Compressions are fast (30 compressions within 18 seconds)
        1. Avoid rates above 140 beats per minute (associated with worse outcomes)
        2. Idris (2012) Circulation 125(24): 3004-12 [PubMed]
      4. Hands-only CPR (without breaths) is recommended for untrained rescuers
    2. Cardiac Compressions are continued, interrupted only for <10 seconds for rhythm checks and Defibrillation
      1. Bedside focused Echocardiogram performed during rhythm checks
      2. Intubate without interrupting compressions
    3. Automatic compression devices (e.g. Lucas) are recommended where available
      1. Improved short-term outcomes (but not long-term outcomes to date)
    4. Induced Therapeutic Hypothermia
      1. Improved neurologic outcomes in patients with ROSC
  3. PALS and APLS includes a rapid global assessment tool
    1. See Pediatric Assessment Triangle

III. Preparation: Emergency Department

  1. First 2-3 minutes prior to patient arrival is critical to successful Resuscitation and survival
  2. Gather Resuscitation team together prior to Ambulance arrival
  3. Roles are assigned prior to patient arrival (consider applying labels to front of gowns)
    1. Provider Running the Resuscitation or code stands at the foot of the bed
    2. Provider managing the airway and neurologic evaluation stands at the head of the bed
  4. Preparation Mnemonic: AEIOU
    1. Advanced Airway equipment
      1. Place in Resuscitation room
      2. Provider responsible for airway is at head of bed
    2. End-Tidal CO2 detector
      1. Connect and prepare device
    3. Intraosseous Line
      1. Confirm IO kit is available
    4. Organization and Order
      1. Gather and role assignment (see above)
    5. Ultrasound
      1. Place in Resuscitation room and prepare (turn on, select probe and apply gel)
  5. Paramedic report and transfer of care should be initial focus on patient arrival
    1. Allow paramedics to give history, findings, answer team questions, relay Resuscitation efforts
    2. Avoid chatter that interferes with the team hearing paramedic report
  6. References
    1. Herbert et al in Herbert (2016) EM:Rap 16(3): 5-6

IV. Approach: Pronouncement of death in the field

  1. Specific circumstances
    1. Asystole
      1. Indications to continue efforts
        1. Initial rhythm of Asystole in unwitnessed arrest without obvious signs of death
      2. Indications to cease efforts
        1. Persistent Asystole for >20 minutes of Resuscitation efforts (Neuro intact survival <1%)
    2. Pulseless Electrical Activity (PEA)
      1. Indications to continue efforts
        1. Heart Rate >40-60 per minute
        2. End-Tidal CO2 trending >20
      2. Indications to cease efforts
        1. Point-of-care Ultrasound without cardiac activity
        2. End-Tidal CO2 persistently 5 or less for 20-25 minutes despite Resuscitation
        3. Persistent PEA for >60 minutes of Resuscitation efforts (Neuro intact survival <2%)
        4. Age alone does not impact decision to continue Resuscitation
    3. Obesity and Pseudo-EMD
      1. Obese patients are at high risk for Pseudo-EMD (pulses not palpable due to Obesity)
      2. Consider empiric IV fluid bolus (and Vasopressor) if Pseudo-EMD suspected
      3. Transport and Emergency Echocardiogram for cardiac standstill if in doubt
      4. Allow for adequate Resuscitation efforts before pronouncement
        1. Duration of code until ROSC is >20 minutes in 25% of Cardiac Arrest cases
        2. Goldberger (2012) Lancet 380(9852): 1473-81 [PubMed]
  2. Criteria (all three together predict 0% chance of survival)
    1. No Return of Spontaneous Circulation (ROSC) prior to transport AND
    2. Cardiac Arrest was not witnessed AND
    3. Rhythm was not shockable
    4. Morrison (2009) Resuscitation 80(3): 324-8 [PubMed]
  3. References
    1. Braude and Myers in Herbert (2016) EM:Rap 16(2): 18-9
    2. Shinar and Swadron in Majoewsky (2013) EM:Rap 13(3): 4-5

V. Management: Assess Responsiveness

  1. Responsive
    1. See Rapid ABC Assessment
  2. Unresponsive
    1. See Altered Level of Consciousness
    2. Call for Help
      1. Call for Defibrillator if available
      2. Activate EMS after initial ABC assessment

VI. Management: Emergency Airway

  1. See Primary Survey Airway Evaluation
  2. Position
    1. Turn on back as unit
    2. Support head and neck while positioning
    3. Place on hard firm surface
  3. Open airway
    1. Jaw Thrust (if suspected neck injury)
    2. Head Tilt-Chin Lift Maneuver
  4. Trauma points (Primary Survey Airway Evaluation )
    1. Is the patient speaking or vocalizing?
    2. Observe for foreign bodies, dentures and facial deformities interfering with airway maintenance
    3. Primary Survey Disability Evaluation (brief Neurologic Exam)
      1. Also described below as the D-part of the ABCDE Trauma algorithm
      2. Can be performed with airway (GCS, pupils and motor in all extremities)
      3. Critical to perform with airway if RSI or Sedation administered

VII. Management: Emergency Breathing

  1. See Primary Survey Breathing Evaluation
  2. Breathing is assessed by medical providers concurrently with responsiveness
    1. Look Listen and feel for breathing has been removed from the ACLS and PALS sequence
  3. Rescue breaths are now started after one cycle of compressions (in Cardiac Arrest)
    1. New sequence: Compressions, open airway, give breaths
  4. Attempt 2 ventilations (each lasting 1 second) if not breathing
    1. Observe chest rise
    2. Allow deflation between breaths
    3. Reposition if first breath does not go in
  5. Airway Obstruction (if ventilations unsuccessful)
    1. No blind finger sweeps at any age
    2. Unconscious
      1. Deliver full CPR regardless of airway obstruction
    3. Conscious
      1. Perform Heimlich Maneuver
        1. Infants: 5 chest thrusts and 5 back blows
        2. Children: 5 abdominal thrusts
        3. Adults: 6-10 abdominal thrusts
      2. Attempt ventilation
      3. Repeat cycle until obstruction cleared
  6. Trauma points (Primary Survey Breathing Evaluation)
    1. Palpate the chest for deformities, Flail Chest or open wounds
    2. Breath sounds are most useful when absent
      1. Treat asymmetrically absent breath sounds as a Pneumothorax
      2. Presence of breath sounds does not exclude Pneumothorax

VIII. Management: Emergency Circulation

  1. See Primary Survey Circulation Evaluation
  2. Assess for Pulse (health care providers)
    1. Brachial pulse in infants
    2. Carotid pulse in children and adults
  3. Pulse Present: Perform Rescue Breathing (reassess every 2 minutes)
    1. Endotracheal Tube: 1 breath per 6-8 seconds for all ages (8-10 breaths per minute)
    2. Adult: 12 breaths per minute (every 5 seconds)
    3. Child: 15 breaths per minute (every 3-5 seconds)
    4. Infant: 20 breaths per minute (every 3-5 seconds)
  4. Pulse Absent: Chest Compressions
    1. General
      1. Pulse check should be <10 seconds
      2. Perform 5 cycles in 2 minutes
      3. Reassess pulse and rhythm every 2 minutes
      4. Focus on pressing hard and fast with minimal interruptions
      5. Connect Automatic External Defibrillator as soon as available
      6. Time interval for lone rescuer calling for help
        1. Sudden Collapse: Call immediately
          1. Minimizes time to AED application
        2. Asphyxial arrest: Perform CPR for 2 minutes
      7. Two rescuers switch places every 2 minutes
        1. Prevents rescuer Fatigue with Chest Compressions
        2. Repeat pulse and rhythm checks with the change
    2. Infants (Under 1 year old)
      1. Place 2 fingers at just below mid-nipple line
      2. Compress over 100 times per minute
        1. Depth: One third of chest depth (1.5 inches or 4 cm)
        2. Ratio: 30 compressions to 2 breaths
    3. Children (1-8 years old)
      1. One hand placed over Sternum at center of chest (superior to xiphoid)
      2. Compress over 100 times per minute
        1. Depth: One third of chest depth (2 inches or 5 cm)
        2. Compression to ventilation ratio
          1. One rescuer: 30:2
          2. Two health care providers: 15:2
    4. Adults (over 8 years old)
      1. Two hands places over Sternum at center of chest (superior to xiphoid)
      2. Compress 100 times per minute
        1. Depth: 2 inches or 5 cm
        2. Compression to ventilation ratio: 30:2 (one or two rescuers)
  5. Trauma Points (Primary Survey Circulation Evaluation)
    1. See Primary Survey Circulation Evaluation
    2. Warm feet are a reassuring sign (cold feet might suggest shock state)
    3. Palpate the Abdomen for distention or signs of injury
    4. Compress the Pelvis by pushing both iliac crests together with force
      1. Assess for anterior or posterior palvis injury
      2. If the Pelvis moves inward on compression, hold this position and apply a Pelvic Binder for stabilization
      3. Do not repeat this exam in an unstable Pelvis

IX. Management: Trauma Disability Points (Primary Survey Disability Evaluation)

  1. May be performed simultaneously with the airway evaluation above
  2. Glasgow Coma Scale
  3. Pupil Reaction
  4. Can patient move all extremities?
    1. In Trauma, do not paralyze and intubate the patient prior to assessing for spinal cord injury with paralysis

X. Management: Trauma Exposure Points (Primary Survey Exposure Evaluation)

  1. All clothing should be removed to completely assess for injuries
  2. Exposure Penetrating Trauma first
  3. Mnemonic: Armpits, Back, Butt cheeks and Sac
    1. Assess for easily missed sites of injury
  4. Apply warm blankets

XI. Management: Trauma - Additional Points

  1. Fast and Glucose/Girl (F and G in the Trauma ABCDEFG)
    1. Perform FAST Exam (Ultrasound)
    2. Check Serum Glucose
    3. Check serum or Urine Pregnancy Test
  2. Spine Precautions
    1. Backboard may be discontinued when Primary Survey completed (if spine evaluation negative)
  3. Imaging
    1. CT Head
      1. Indicated for signs of Head Injury (especially if anticoagulated, Intoxication)
      2. See Head Injury CT Indications in Adults
      3. See Head Injury CT Indications in Children (PECARN)
    2. CT C-Spine
      1. Indicated for any ill patient who needs spine imaging (replaces Cross Table lateral XRay)
      2. See Cervical Spine Imaging in Acute Traumatic Injury (e.g. NEXUS Criteria)
    3. Chest XRay for all Trauma patients
    4. CT Abdomen and Pelvis
      1. May skip if benign Abdomen and Pelvis without pain, tenderness and if vitals signs stable

XII. Management: Rhythm - Pulse Absent in adults and children (ACLS and PALS)

  1. See Reversible Causes of Cardiopulmonary Arrest (5H5T)
  2. Shockable Rhythm: Ventricular Fibrillation or Pulseless Ventricular Tachycardia
    1. Defibrillate every 2 minutes
      1. Adult: Biphasic dose varies by device (120-200 J); Monophasic dose 360 J
      2. Children: Start at 2-4 J/kg, then 4 J/kg
    2. CPR
      1. Performed continuously between shocks (minimal interruptions)
    3. Alpha-adrenergic agent (choose one)
      1. Epinephrine
        1. Adult: 1 mg every 3-5 minutes
        2. Child: 0.01 mg/kg (0.1 ml/kg of 1:10,000) repeated every 3-5 minutes
      2. Vasopressin (not commonly used in community EDs)
        1. Adult: 40 units for 1 dose
    4. Antiarrhythmic
      1. Amiodarone (preferred)
        1. Adult: 300 mg IV (may subsequently repeat once at dose 150 mg)
        2. Child: 5 mg/kg bolus (and may be repeated up to twice for refractory VF/VT)
      2. Lidocaine (alternative for adults, not recommended in children)
        1. Adult: 1-1.5 mg/kg IV (may subsequently repeat dose at 0.5 to 0.75 mg/kg)
    5. Magnesium (for Torsades de Pointes)
      1. Adult: 1-2 g IV
      2. Child: 25 to 50 mg/kg IV or IO
  3. Non-shockable Rhythm: Asystole or Pulseless Electrical Activity (PEA)
    1. Key management is to identify and treat Reversible Causes of Cardiopulmonary Arrest (5H5T)
    2. Epinephrine
      1. Adult: 1 mg every 3-5 minutes
      2. Child: 0.01 mg/kg (0.1 ml/kg of 1:10,000) repeated every 3-5 minutes
    3. Vasopressin (not commonly used in community EDs)
      1. Adult: 40 units for 1 dose
    4. Atropine is no longer recommended as of 2010 guidelines
      1. Was previously given at 1 mg IV for Asystole or Slow PEA
  4. Other measures
    1. Vasopressin 20 units (experimental)
      1. Vasopressin is given in addition to Epinephrine per protocol
        1. Vasopressin may be better at maintaining brain perfusion
        2. Epinephrine appears better at achieving ROSC
      2. Consider vasopressin when low End-Tidal CO2 (e.g. 20) despite high quality CPR
      3. Early studies suggest improved survival
      4. Orman and Weingart in Herbert (2015) EM:Rap 15(1): 14-6
      5. Mentzelopoulus (2013) JAMA 310(3): 270-9 [PubMed]

XIII. Management: Rhythm - Pulse Present - Unstable in adults and children (ACLS and PALS)

  1. See Reversible Causes of Cardiopulmonary Arrest (5H5T)
  2. Indications for unstable status
    1. Chest Pain
    2. Hypotension or other signs of shock
    3. Altered Level of Consciousness
  3. Bradycardia (symptomatic with hemodynamic instability)
    1. See Unstable Bradycardia
    2. Perform CPR in children for Heart Rate <60/min with signs of hypoperfusion
    3. Atrioventricular Block (AV Block): Mobitz 2 or third degree
      1. Transcutaneous Pacing
      2. Prepare for Transvenous Pacing
    4. No AV Block (or first degree or Wenckebach)
      1. Adults
        1. Atropine 0.5 mg IV (may repeat up to a cummulative total of 3 mg)
        2. Transcutaneous Pacing
        3. Chronotropes (alternative to transcutaneous pacing)
          1. Epinephrine 2-10 mcg/min
          2. Dopamine 2-10 mcg/kg/min
      2. Children
        1. Epinephrine 0.01 mg/kg (0.1 ml/kg of 1:10,000) repeated every 3-5 minutes
        2. Atropine 0.02 mg.kg and may repeated once (min to max dose: 0.1 mg to 0.5 mg)
          1. Indicated if increased vagal tone or primary Atrioventricular Block
        3. Transcutaneous Pacing
  4. Tachycardia: Synchronized Cardioversion
    1. See Unstable Tachycardia
    2. Conscious Sedation if no delays
    3. Adults
      1. Start at 120 joules for biphasic Defibrillator or 50 Joules for monophasic Defibrillator
        1. Paroxysmal Supraventricular Tachycardia (PSVT)
        2. Atrial Flutter
      2. Start at 150 joules for biphasic Defibrillator or 100 Joules for monophasic Defibrillator
        1. Atrial Fibrillation
        2. Monomorphic Ventricular Tachycardia
      3. Start at 200 joules for biphasic Defibrillator or 360 Joules for monophasic Defibrillator
        1. Polymorphic Ventricular Tachycardia (Unsynchronized shock will likely be required)
    4. Children
      1. Initial: 0.5 to 1 J/kg
      2. Refractory: 2 J/kg

XIV. Management: Rhythm - Pulse Present - Stable - Bradycardia in adults and children (ACLS and PALS)

  1. Indicated if unstable criteria above not met
  2. Bradycardia
    1. Evaluate for Sinus Bradycardia causes
    2. Observe for change in status

XV. Management: Rhythm - Pulse Present - Stable - Tachycardia in Adults (ACLS)

  1. Indicated if unstable criteria above not met
  2. See Reversible Causes of Cardiopulmonary Arrest (5H5T)
  3. Wide Complex Tachycardia (QRS wider than 0.12 msec)
    1. Regular Wide Complex Tachycardia
      1. Start with Adenosine 6 mg IV (may repeat with 12 mg IV)
        1. Benign, slows the rhythm for interpretation and helps to differentiate SVT with aberrancy from VT
      2. Supraventricular Tachycardia with Aberrancy
        1. Treat as Regular Narrow Complex Tachycardia (see below)
      3. Ventricular Tachycardia
        1. Amiodarone 150 mg IV over 10 min (followed by infusion)
          1. Procainamide is more effective than Amiodarone and may be preferred if no CHF or Prolonged QT Interval
        2. Synchronized Cardioversion
        3. Alternative Antiarrhythmics
          1. Procainamide (if no CHF and no Prolonged QT Interval)
          2. Sotalol 100 mg (1.g mg/kg) IV over 5 min (if no Prolonged QT Interval)
    2. Irregular Wide Complex Tachycardia
      1. Atrial Fibrillation with WPW
        1. Amiodarone 150 mg IV
        2. Consult with cardiology
        3. Avoid Beta Blockers, Calcium Channel Blockers, Digoxin, Adenosine
      2. Atrial Fibrillation with aberrancy
        1. Treat as Irregular Narrow Complex Tachycardia (see below)
      3. Torsades de Pointes
        1. Magnesium 1-2 grams IV
        2. Synchronized Cardioversion (or Defibrillation if unable to sync)
        3. Over-drive transcutaneous pacing
  4. Narrow Complex Tachycardia
    1. Regular Narrow Complex Tachycardia
      1. Vagal Maneuvers
      2. Adenosine 6 mg and may repeat at 12 mg dose
        1. Conversion with Adenosine suggests Paroxysmal Supraventricular Tachycardia (PSVT)
        2. Recurrence can be treated with Adenosine, Diltiazem or Lopressor
      3. Rate control
        1. Refractory to Adenosine suggests Atrial Flutter, ectopic Atrial Tachycardia or junctional Tachycardia
        2. Rate control with Diltiazem or Lopressor (see below)
    2. Irregular Narrow Complex Tachycardia
      1. Occurs with Atrial Fibrillation, Atrial Flutter or Multifocal Atrial Tachycardia (MAT)
      2. Avoid Adenosine (risk of Ventricular Fibrillation)
      3. Rate control
        1. Diltiazem
          1. Bolus 1: 20 mg (0.25 mg/kg) IV bolus over 2 min
          2. Bolus 2: 25 mg (0.35 mg/kg) IV bolus over 2 min (if indicated, and at least 15 min after first)
          3. Drip: 10 mg/hour (typical range: 5-15 mg/hour)
        2. Metoprolol (Lopressor)
          1. Avoid in acute CHF or COPD exacerbation
          2. Bolus: 2.5 to 5 mg IV every 2-5 min (maximum 15 mg in 15 min)

XVI. Management: Rhythm - Pulse Present - Stable - Tachycardia in Children (PALS)

  1. Indicated if unstable criteria above not met
  2. See Reversible Causes of Cardiopulmonary Arrest (5H5T)
  3. Wide Complex Tachycardia (QRS wider than 0.09 msec; contrast with 0.12 in adults)
    1. Consider Ventricular Tachycardia
    2. Unstable Wide Complex Tachycardia
      1. See Unstable Tachycardia above
      2. Synchronized Cardioversion
    3. Stable, regular Wide Complex Tachycardia
      1. Consider SVT with aberrancy if monomorphic QRS and regular rhythm
      2. Adenosine
        1. Do not use Adenosine if rhythm irregular (risk of WPW or rhythm degeneration)
        2. First: 0.1 mg/kg (maximum 6 mg)
        3. Second: 0.2 mg/kg (maximum 12 mg)
    4. Stable, irregular or refractory Wide Complex Tachycardia
      1. Precautions
        1. Consult cardiology about recommended Antiarrhythmic
        2. Avoid combining Amiodarone and Procainamide
      2. Agents
        1. Amiodarone 5 mg/kg over 20-60 minutes
        2. Procainamide 15 mg/kg IV over 30-60 minutes
  4. Narrow Complex Tachycardia (QRS 0.09 msec or less; contrast with 0.12 in adults)
    1. Sinus Tachycardia
      1. Normal P Waves, variable R-R with a constant PR interval, and Heart Rate <180 in children (<220 in infants)
      2. See Sinus Tachycardia
      3. Indentify and treat underlying cause
    2. Supraventricular Tachycardia
      1. Abnormal or absent P Waves with constant Heart Rate >180 in children (>220 in infants)
      2. Vagal Maneuvers if no delays
      3. Adenosine (if regular rhythm)
        1. Do not use Adenosine if rhythm irregular (risk of WPW or rhythm degeneration)
        2. First: 0.1 mg/kg (maximum 6 mg)
        3. Second: 0.2 mg/kg (maximum 12 mg)
      4. Synchronized Cardioversion
        1. Indicated for irregular rapid rhythm or SVT refractory to above measures

XVII. Management: Additional measures

  1. See Reversible Causes of Cardiopulmonary Arrest

XVIII. Resources

  1. Cardiopulmonary Resuscitation Guidelines
    1. http://www.circulationaha.org

XIX. References

  1. Trauma
    1. (2008) ATLS Manual, American College of Surgeons
    2. Majoewsky (2012) EMR:RAPC3 2(1): 1-2
  2. Cardiopulmonary Resuscitation Guidelines
    1. Mace (2013) Crit Dec Emerg Med 27(1): 11-20
    2. Mace (2013) Crit Dec Emerg Med 27(2): 2-10
    3. (2010) Guidelines for CPR and ECC [PubMed]
    4. (2005) Circulation 112(Suppl 112):IV [PubMed]
    5. (2000) Circulation, 102(Suppl I):86-9 [PubMed]

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Ontology: Cardiopulmonary Resuscitation (C0007203)

Definition (MEDLINEPLUS)

When someone's blood flow or breathing stops, seconds count. Permanent brain damage or death can happen quickly. If you know how to perform cardiopulmonary resuscitation (CPR), you could save a life. CPR is an emergency procedure for a person whose heart has stopped or is no longer breathing. CPR can maintain circulation and breathing until emergency medical help arrives.

Even if you haven't had training, you can do "hands-only" CPR for a teen or adult whose heart has stopped beating ("hands-only" CPR isn't recommended for children). "Hands-only" CPR uses chest compressions to keep blood circulating until emergency help arrives. If you've had training, you can use chest compressions, clear the airway, and do rescue breathing. Rescue breathing helps get oxygen to the lungs for a person who has stopped breathing. To keep your skills up, you should repeat the training every two years.
Definition (CSP) the artificial substitution of heart and lung action as indicated for heart arrest resulting from electric shock, drowning, respiratory arrest, or other causes; the two major components of cardiopulmonary resuscitation are artificial ventilation and closed-chest cardiac massage.
Definition (MSH) The artificial substitution of heart and lung action as indicated for HEART ARREST resulting from electric shock, DROWNING, respiratory arrest, or other causes. The two major components of cardiopulmonary resuscitation are artificial ventilation (RESPIRATION, ARTIFICIAL) and closed-chest CARDIAC MASSAGE.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D016887
ICD9 99.60
ICD10 92052-00
SnomedCT 182610000, 150819003, 89666000
CPT 92950
English Cardio Pulmonary Resuscitation, Cardio-Pulmonary Resuscitation, CPR, Resuscitation, Cardio-Pulmonary, heart resuscitation, CARDIOPULMONARY RESUSCITATION, Resuscitation, Cardiopulmonary, CPR - Cardiopulm resuscitation, CARDIOPULM RESUSCITATION, CARDIO PULM RESUSCITATION, CPR (cardiopulmonary resuscitation), cardiopulmonary resuscitation (treatment), cardiopulmonary resuscitation, Cardiopulm resuscita NOS, Cardiopulmonary resuscitation (eg, in cardiac arrest), Compression;chest;heart, cardio-pulmonary resuscitation, cardiopulmonary resuscitation (CPR), Cardiopulmonary Resuscitation, Cardiopulmonary resuscitation (& closed cardiac massage & ventilation) (procedure), Closed cardiac massage+ventil., Cardiopulmonary resuscitation (& closed cardiac massage & ventilation), CPR - Cardiopulmonary resuscitation, Cardiopulmonary resuscitation, Cardiopulmonary resuscitation (procedure), Cardiopulmonary resuscitation, NOS, HEART/LUNG RESUSCITATION CPR, Heart/lung resuscitation cpr, Cardiopulmonary resuscitation, not otherwise specified
Swedish Hjärt-lungräddning
Czech kardiopulmonální resuscitace
Finnish Puhallus-paineluelvytys
Russian ROT V ROT REANIMATSIIA, REANIMATSIIA PO SPOSOBU ROT V ROT, KARDIOPUL'MONAL'NAIA REANIMATSIIA, SERDECHNO-LEGOCHNAIA REANIMATSIIA, К�РДИОПУЛЬМО��ЛЬ��Я РЕ��ИМ�ЦИЯ, РЕ��ИМ�ЦИЯ ПО СПОСОБУ РОТ В РОТ, РОТ В РОТ РЕ��ИМ�ЦИЯ, СЕРДЕЧ�О-ЛЕГОЧ��Я РЕ��ИМ�ЦИЯ
Japanese マウス･ツー･マウス人工呼�法, 人工呼�-�対�, 心肺蘇生術, �対�人工呼�法, 心肺蘇生法, �-�人工呼�法
French RCP (Réanimation CardioPulmonaire), Réanimation cardiorespiratoire, RCR (Réanimation CardioRespiratoire), Réanimation cardio-pulmonaire, Réanimation cardiopulmonaire
Italian CPR, Rianimazione cardiopolmonare
Polish Podstawowe zabiegi resuscytacyjne, CPR, Resuscytacja krążeniowo-oddechowa
Croatian KARDIOPULMONALNA REANIMACIJA
Norwegian Hjerte-lunge-redning, CPR, HLR
Spanish Reanimación Cardiopulmonar, Respiración Boca a Boca, Reanimación Cardiopulmonar Básica, RCP, reanimación cardiopulmonar (procedimiento), reanimación cardiopulmonar, CPR, Resucitación Cardiopulmonar
Portuguese Manutenção das Condições Vitais Cardíacas Básicas, Reanimação Cardiopulmonar, Suporte das Condições Vitais Cardíacas Básicas, Respiração Boca-a-Boca, CPR, Ressuscitação Cardiopulmonar
German CPR, Kardiopulmonale Reanimation, Kardiopulmonale Wiederbelebung, Herz-Lungen-Wiederbelebung
Dutch CPR, Resuscitatie, cardiopulmonale
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Cardiac Arrest (C0018790)

Definition (MSHCZE) Zastavení srde�ního rytmu nebo stahů (MYOKARD – KONTRAKCE). Je-li srde�ní �innost obnovena během několika minut, může být srde�ní zástava ve většině případů bez následků obrácena zpět do normálního srde�ního rytmu a tím i krevního oběhu. R
Definition (MEDLINEPLUS)

The heart has an internal electrical system that controls the rhythm of the heartbeat. Problems can cause abnormal heart rhythms, called arrhythmias. There are many types of arrhythmia. During an arrhythmia, the heart can beat too fast, too slow, or it can stop beating. Sudden cardiac arrest (SCA) occurs when the heart develops an arrhythmia that causes it to stop beating. This is different than a heart attack, where the heart usually continues to beat but blood flow to the heart is blocked.

There are many possible causes of SCA. They include coronary heart disease, physical stress, and some inherited disorders. Sometimes there is no known cause for the SCA.

Without medical attention, the person will die within a few minutes. People are less likely to die if they have early defibrillation. Defibrillation sends an electric shock to restore the heart rhythm to normal. You should give cardiopulmonary resuscitation (CPR) to a person having SCA until defibrillation can be done.

If you have had an SCA, an implantable cardiac defibrillator (ICD) reduces the chance of dying from a second SCA.

NIH: National Heart, Lung, and Blood Institute
Definition (NCI_CDISC) Cardiac arrest is the non-fatal, sudden cessation of cardiac activity so that the victim subject/patient becomes unresponsive, with no normal breathing and no signs of circulation. Cardiac arrest should be used to signify an event as described above that is reversed, usually by CPR, and/or defibrillation or cardioversion, or cardiac pacing.
Definition (NCI_CTCAE) A disorder characterized by cessation of the pumping function of the heart.
Definition (NCI_FDA) Sudden cessation of the pumping function of the heart, with disappearance of arterial blood pressure, connoting either ventricular fibrillation or ventricular standstill.
Definition (NCI) The sudden cessation of cardiac activity in an individual who becomes unresponsive, without normal breathing and no signs of circulation. Cardiac arrest may be reversed by CPR, and/or defibrillation, cardioversion or cardiac pacing.
Definition (CSP) cessation of the heart beat.
Definition (MSH) Cessation of heart beat or MYOCARDIAL CONTRACTION. If it is treated within a few minutes, heart arrest can be reversed in most cases to normal cardiac rhythm and effective circulation.
Concepts Disease or Syndrome (T047)
MSH D006323
ICD9 427.5
ICD10 I46 , I46.9
SnomedCT 251189000, 30298009, 309810002, 195085006, 195090009, 397912004, 155372006, 397829000, 410429000
LNC LP133247-9, MTHU041449, LA17068-0, LA17496-3, LA9535-1
English Arrest, Heart, Asystole, Asystoles, Heart Arrest, ASYSTOLIA, Arrest, Cardiac, VENTRICULAR ASYSTOLIA, Cardiac arrest - asystole, Cardiac arrest, unspecified, CA - Cardiac arrest, Cardiac Arrest, cardiac arrest, cardiac arrest (diagnosis), asystole (diagnosis), asystole, Arrest cardiac, Heart arrest, Ventricular asystole, Asystolia, Ventricular asystolia, Asystolic, Standstill cardiac, Heart Arrest [Disease/Finding], arrest [as an cardiac arrest], asystolia, ventricular asystole, cardiac asystole, heart arrest, arrest, arrested, Cardiac arrest, unspecified (disorder), Asystole (finding), SCA, ASYSTOLE, ARREST, CARDIAC, CARDIAC ARREST, Cardiac arrest- asystole, Cardiac standstill, Asystole (disorder), heart; arrest, heart; stoppage, stoppage; heart, ventricular; arrest, arrest; cardiac, arrest; ventricular, Cardiac arrest, Cardiac arrest (disorder)
French ARRET CARDIAQUE, Asystolie, Arrêt des contractions du coeur, Asystole ventriculaire, Asystolique, Arrêt du coeur, Asystole, ASYSTOLIE VENTRICULAIRE, ASYSTOLIE, Pause cardiaque, Arrêt cardiaque, Arrêt cardio-circulatoire, Arrêt cardiocirculatoire
Portuguese PARADA CARDIACA, Assístolia, Assistólico, ASSISTOLIA VENTRICULAR, ASSISTOLIA, Parada Cardiorrespiratória, Paralisia Cardíaca, Assistolia ventricular, Paragem cardíaca, Assistolia, Parada Cardíaca
Spanish PARO CARDIACO, ASISTOLIA, Asistólico, Paro cardiaco, Asístole, Parada Cardíaca, ASISTOLIA VENTRICULAR, paro cardíaco, no especificado, paro cardíaco, no especificado (trastorno), asístole, Cardiac arrest, unspecified, Parada Cardiorrespiratoria, Parálisis Cardíaca, Parada Cardiopulmonar, Paro Cardiorrespiratorio, asistolia (trastorno), asistolia, Asistolia ventricular, Parada cardiaca, paro cardíaco (trastorno), paro cardíaco, Asistolia, Paro Cardíaco
German HERZSTILLSTAND, Asystolisch, Stillstand Herz, ASYSTOLIE, Herzstillstand, nicht naeher bezeichnet, VENTRIKULAERE ASYSTOLIE, ventrikulaere Asystolie, Asystolie, Herzstillstand, Kardialer Stillstand
Italian Asistole ventricolare, Asistolico, Asistolia, Asistolia ventricolare, Asistole, Arresto cardiaco
Dutch asystolie, ventriculaire asystolie, stilstand van het hart, asystole, asystolisch, hart; stilstand, hart; stoppen, stilstand; hart, stilstand; ventriculair, stoppen; hart, ventriculair; stilstand, Hartstilstand, niet gespecificeerd, hartstilstand, ventriculaire asystole, Arrest, cardiaal, Asystolie, Hartstilstand, Stilstand, hart-
Japanese 心室無�縮, ｼ�ｼﾂﾑｼｭｳｼｭｸ, ｼ�ﾃｲｼ, 心肺�止, 心��止, �全�縮期, ｼ�ｾｲｼ, 心�止, 心臓�止, 心�止
Swedish Hjärtstopp
Czech srdce - zástava, Srde�ní zástava, Asystolie, Zástava srdce, Komorová asystolie, asystolie
Finnish Sydämenpysähdys
Russian ASISTOLIIA, SERDTSA OSTANOVKA, SERDTSA I DYKHANIIA OSTANOVKA, �СИСТОЛИЯ, СЕРДЦ� И ДЫХ��ИЯ ОСТ��ОВК�, СЕРДЦ� ОСТ��ОВК�
Korean 심장정지, �세불명� 심장정지
Croatian SRÄŒANI ZASTOJ
Polish Zatrzymanie czynności serca, Asystolia, Nagłe zatrzymanie krążenia, Zatrzymanie akcji serca
Hungarian Ventricularis asystole, Asystole, Asystoliás, Szívmegállás, Szív nem működik, Asystolia, Szív megállása, Cardialis leállás, Ventricularis asystolia
Norwegian Hjertestans, Hjertestopp, Asystoli
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Resuscitation procedure (C0035273)

Definition (NCI) The measures applied for the restoration a person to life and/or consciousness. The act of resuscitation includes such components as artificial respiration and cardiac massage.
Definition (MSH) The restoration to life or consciousness of one apparently dead. (Dorland, 27th ed)
Definition (CSP) restoration to life or consciousness.
Definition (NIC) Administering emergency measures to sustain life
Concepts Therapeutic or Preventive Procedure (T061)
MSH D012151
SnomedCT 439569004
English Resuscitation, Resuscitations, Resuscitation (procedure), Resuscitation procedure, resuscitation
Japanese 蘇生法, ｿｾｲﾎｳ
Swedish Ã…terupplivning
Czech kříšení, resuscitace, Resuscitace
Finnish Elvytys
Russian REANIMATSIIA, РЕ��ИМ�ЦИЯ
French Ressuscitation, Réanimation
Spanish reanimación, reanimación (procedimiento), Resucitación
Croatian REANIMACIJA
Polish Resuscytacja, Ożywianie
Hungarian Resuscitatio
Norwegian Gjenopplivning, Livredning
Portuguese Reanimação, Ressuscitação
Dutch reanimatie, Reanimatie, Resuscitatie
German Reanimation, Wiederbelebung
Italian Rianimazione
Derived from the NIH UMLS (Unified Medical Language System)

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