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

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

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

ECG:Sınus arrest No P waves.

ECG: VF

ECG: Polimorphic VT (Torsade de Pointes)

ECG: Complete AV Block Dissociate P an QRS waves.

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.

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

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).

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

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

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

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

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

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

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

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

Eksternal Defibrilator- Localization of Pedals

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

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.

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 : 90- 100/min At the end of compression 2 full breaths should be given; if endotracheal tube is inplace; 5 chest compression / 1 ventilation

ABC of CPR

Autamated External DFB.

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).

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