Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Cardiac Arrest 279

Thrombosis (coronary)

Thrombosis (pulmonary)

■Asystole

➣Confirm asystole: check lead placement, power, gain

➣Dismal prognosis; consider DNR order

➣Epinephrine 1 mg IV push q3–5 min

➣Consider transcutaneous pacing.

Consider allowing family member presence during resuscitative

efforts (shown to ease the grieving process). Assign staff person to

accompany family member and answer questions.

follow-up

Termination of Resuscitative Efforts

■In the absence of mitigating factors, resuscitation unlikely to be suc-

cessful and can be discontinued if there is no return of spontaneous

circulation during 30 minutes of Advanced Cardiac Life Support (15

min for newborn infants).

■Debriefing of code team. Review and analyze sequence of interven-

tions. Allow free discussion and constructive criticism from all mem-

bers. Allow expression of feelings.

■Notify family/friends. Do not announce death over the phone. Allow

time for shock, grieving. Answer questions about circumstances of

death, disposition of body. Allow family to see body.

■Consider autopsy or organ/tissue donation.

■Training practice of lifesaving procedures on newly dead patients

only under defined educational programs

Successful Resuscitation

■Survival to discharge after an in-hospital cardiac arrest usually <15%

■Prognostic factors: most important factor istime of resuscitative

efforts. Time to CPR, time to defibrillation, comorbid disease, prear-

rest state, and initial arrest rhythmare not clearly predictive of out-

come.

■Prognosis for neurologic outcome in comatose patients best

assessed 2–3 days after arrest. 3 factors associated with poor out-

come:

➣absence of pupillary response to light on the 3rd day

➣absence of motor response to pain by the 3rd day

➣bilateral absence of cortical response to somatosensory evoked

potentials within the first week