1. SUDDEN CARDIAC DEATH PREVENTION AND CARDIO-PULMONARY RESSUSSITATION (CPR)
Rasim ENAR; M.D
Professor of Cardiology
İstanbul University
Cerrahpaşa Medical Faculty
Department of Cardiology

2. SUDDEN CARDIAC DEATH (SCD)
Definition:
“Natural Death due to cardiac causes
(1) Loss of consciousness within one hour after start of the symptoms
(2) Pre-existing heart disease may be present; but the cause or the timing of the death can not be predicted
Keys of Definition :
(a) Non-taumatic nature
(b) Unexpected and sudden

3. CARDIAC ARREST Definition: Sudden cessation of cardiac pump function
Reversible with rapid and effective intervention;
otherwise cardiac death is unevitable
►►► The common electrophysological mechanism which cause cardiac arrest as a cause of SCD:
(1)- Ventricular Tachyarrhytmias; Ventricular Fibrillation, Ventricular Tachycardia
(2)- Non-Tachyarrhytmic causes ; Other important causes of cardiac arrest;
Pulseless electrical activity (Electromachanical Dissosiation);
Asistoly;
Bradiarrhythmias

4. ECG:Sınus arrest
No P waves.

5. ECG: VF

6. ECG: Polimorphic VT (Torsade de Pointes)

7. ECG: Complete AV Block
Dissociate P an QRS waves.

8. ETY-1: SCD- CARDIOVASCULAR DISEASES:.
►1- Coronary artery disease
Acute coronary sydrome,
Chronic ischemic heart disease
►2- Dilated cardiomyopathy
*► “The above two cinical states is responsible for >90% of SCD events”.
►3- Other cardiomyopathies;
(a) hipertrophic cardiomyopathy,
(b) arrhythmogenic right ventricular cardiomyopathy
►4- Primary “electrical” disturbances.
►5- Mechanical cardiovascular diseases.

9. ETY -2:► 4- Primary “electrical” disturbances:
(a) Long QT syndrome
(b) Brugada syndrome
(c) Cathecholaminergic polimorphic VT.
(d) Wolf-Parkinson-White syndrome (WPW).
(e) Sinus and AV node related conduction
disturbances

10. ETY-3 SCD - Mechanical Cardiyovascular Diseases;
a- Aortic stenosis.
b- Mitral valve prolapse
c- Myocardial bridging
d- Anolomous coronary artery origin
ETY-4 ► SCD- Other Causes:
(a) Myocarditis
(b) Chest trauma
(c) Drug overdose - Torsade de Pointes
(d) Atheletes heart _ trained heart
(e) SCD in normal heart (idiopathic VF).

11. Prevention from SCD:
►Principal: Multi-factorial etiology and various treatment targets.
►Primary prophlaxis: Prevention of fatal arrhythmias in patients without prior sustainead VT and high risk for SCD
►Secondary prophlaxis: Prevention of fatal arrhythmias in patients who exprerienced cardiac arrest and sustained ventricular tachyarrhytmias

12. Primary Proflaxis: 3 different proflactic treatment modalities:
1- Drugs without electrophysiologic effects
2- Drugs with electrophysiologic effects
3- ICD(Implantable Cardiac Defibrillator)

13. 1- Drugs without electrophysiologic effects :
Importance of the treatment: Both total mortality and SCD is reduced.
3 different class drugs:
1- ACE-I (angiootensin converting enzyme inhibitors), ARB (+?)
2- Aldosterone receptor blockers
3- Poli-unsaturated fatty acids (omega-3)
+- Statins

14. RESSUSİTATION.
Return of spontaneous circulation (ROS) can be achived only 15% of cardiac arrest cases, and only 50% of those could be discharged
As a result; There is only a 5-7% chance of survival in cardiac arrst victims.
Survival from cardiac arrest:
(a) Etiolgy of cardiac arrest (VF>EM-Diss),
(b) Pre- cardiac arrest status,
(c) Unwitnessed cardiac arrest
(d) Emergency CPR and availability of
automated external defibrilator

15. CHAIN OF SURVIVAL: (ABLS: Adult Basic Life Support) “Call 112,+Chest compression +Defibrilltor + IV DrugTherapy”.

16. Electrical meaning of Ressussitation:
VF is the most common cause of cardiac arrest
Spontaneous termination does not occur
VF more than 3-4 minutes causes irrversible organ damage.
Prevention of death secondary to cardiac arrest
Immediate, rapid Defibrillation (DFB).
* Every minute delay with DFB reduces life expactancy by 7-10% according to direct CPR with chest compression or entubation

17. External Defibrillator.
Devices with automated rhythm analysis and shock delivery features
External defibrilator (EDFB); should be used only in patients who are unresponsive, not breathing and without effective circulation

18. DEFIBRILATOR(DFB): Manually operated; Paddeles and Monitore.

19. Eksternal Defibrilator- Localization of Pedals

20. Return of NSR (“arrow sign”) after DFB of VF

21. CPR; Cardio-Pulmonary Ressussitation
If immediate DFB is not possible, then CPR should be started without delay.
Late-CPR and/or advanced cardiac life support (ACLS) should be discouraged.
Only 10-20% of out-of hospital VF cases survive and 50% of those will have neurological problems.
As a result: If cardiac arrest is not diagnosed within 4 minutes and CPR and DFB is not given within 8 minutes; ressussitation will be unsuccessful.

22. How to do CPR ? BLS (Basıc Life Support) Algorhthm:
1- Check the responsiveness ; if unresponsive- start CPR:
2- Open Airway; “Head tilt-jaw trust”
►► 3- Check the breathing- not breathing; Start mouth-to-mouth breathing
4- Give your breath ; - Give 1-1,5 seconds break for breathing and observe the patient after the first two full breaths
5- Assess circulation;- Check pulse at carotide artery
►► 6- If no sign of circulation (no pulse); start chest compression
1- 2 rescuer CPR : 15 compression - 2 ventilation.
Rate of compression : /min
At the end of compression 2 full breaths should be given;
if endotracheal tube is inplace; 5 chest compression / 1 ventilation

23. ABC of CPR

24. Autamated External DFB.

25. CPR: “The moment every thing is over or started again “That moment”(
CPR: “The moment every thing is over or started again “That moment”(?!?): First-aid ( Semi-autamated DFB).

26. --VF,-DFB and -Sinüs rhythm. -- “Geçmiş olsun”….