Appendix D: Cardiopulmonary resuscitation
Cardiopulmonary resuscitation begins with basic life support before more advanced techniques can be employed. A logical approach to resuscitation has been produced in detail by the European Resuscitation Council in the British Medical Journal (Vol. 306, 1993, pp. 1587-1593). An outline of the steps involved using algorithms and flow charts in basic and advanced resuscitation (currently under review) are taken from this article (reproduced with permission) (Fig. 48.64).
Cardiac arrest is the cessation of cardiac mechanical activity, confirmed by the absence of a detectable pulse; unresponsiveness and apnoea (or agonal respirations). In adults the most common cause is primary ischaemic heart disease. Cardiac arrest may be associated with any of four heart rhythms: ventricular fibrillation, pulseless ventricular tachycardia, asystole or electromechanical dissociation.
Management of ventricular fibrillation or pulseless ventricular tachycardia - see Fig. 48.65.
Management of asystole - see Fig. 48.66.
Management of electromechanical dissociation - see Fig. 48.67.Drug delivery routes
The venous route is recommended for drug delivery during cardiac arrest. Peripheral venous cannulation is rapid, safe and does not interfere with cardiopulmonary resuscitation. Cannulation of an antecubital vein is the site of choice, although the external jugular vein is an alternative.
Open cardiac massage
Open chest massage is only rarely indicated in advanced cardiac life support for a patient with a medical' cardiac arrest, although emergency thoracotomy in cases of trauma is a well-validated procedure for which clear indications exist.