Cardiac Arrest, Hypothermia and Resuscitation Science Lecture 1: Introduction to resuscitation science Benjamin S. Abella, MD MPhil Clinical Research Director Center for Resuscitation Science Department of Emergency Medicine University of Pennsylvania Coursera July 2012 An introductory course for the educated lay public and health care providers

Dr. Abella: conflicts of interest disclosures Employment: University of Pennsylvania Research funding:National Institutes of Health Philips Healthcare Medtronic Foundation Consulting:Velomedix, Inc. HeartSine Technologies Volunteer:American Heart AssociationSudden Cardiac Arrest Association No equity or intellectual property related to resuscitation science

What is cardiac arrest? Electrical recording of the heart rhythm: Normal rhythm: heart is moving blood (functional “cardiac output”) Cardiac arrest rhythm: chaotic rhythm means no blood flow (no functional cardiac output) In cardiac arrest, the blood pressure quickly falls to zero Blood flow to the organs stops, abruptly and completely

What is cardiac arrest? Without any blood flow to the lungs or brain, the victim of cardiac arrest is technically “dead” and appears lifeless (For brief minutes, may have “gasping” or “seizure” activity) The immediate actions required to restore blood flow: 1.Cardiopulmonary resuscitation (CPR) 2.Electrical defibrillation Both of these can be done by the lay public

History of cardiopulmonary resuscitation (CPR) Something like mouth-to-mouth in the Bible: Kings Chapter 2, Elijah treated a collapsed child – he “put his mouth upon [the child’s] mouth… and the flesh of the child waxed warm” As early as the 1500s, notion of using a bellows to revive victims of drowning and smoke inhalation – fell out of practice in the 1800s

Modern history of CPR and defibrillation Drs. Knickerbocker, Kouwenhoven, and Jude – Johns Hopkins, 1950s – studied defibrillation and chest compressions in the laboratory

1961 A.Peter Safar, 1950s – modern mouth-to-mouth B. Early symposium on CPR A B Modern history of CPR – ventilations and putting it together

Resuscitation and CPR in 2012 Consensus resuscitation guidelines – updated every five years, published in the US by the American Heart Association Worldwide training of CPR Certification courses: BLS – Basic Life Support ACLS – Advanced Cardiovascular Life Support Training programs for using defibrillators Video-based CPR training “Hands-only” CPR (without mouth-to-mouth)

Resuscitation and CPR in 2012 New directions in CPR: Hands-only CPR – evidence suggests mouth-to-mouth may not be required, especially for bystander response New for 2010 guidelines: Airway-Breathing-Circulation is now Circulation-Airway-Breathing C A B …. more on this in lecture 2

Cardiac arrest and heart attack are not the same thing A heart attack (“myocardial infarction” or “MI”) is from blockages in the coronary arteries, blood vessels that feed the heart These blockages grow over years, related to genetic factors, smoking, hypertension, and other risk factors Normal coronary artery Diseased coronary arteries (coronary “plaque”)

Cardiac arrest and heart attack are not the same thing In a heart attack, a complete blockage leads to death of a portion of heart muscle In most cases of heart attack, the victim lives and does not need CPR or defibrillation Treatments for heart attack include: aspirin angioplasty coronary stent placement anticoagulant medications

Cardiac arrest compared to heart attack Pathophysiology Symptoms Cardiac activity Mortality Treatment Cardiac arrest Heart attack Cardiac function Portion of heart muscle Suddenly stops starved of blood flow Sudden collapse chest pain, nausea, shortness of breath NOYES Very high mortality low mortality CPR, defibrillation aspirin, angioplasty