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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
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Dr. Abella: conflicts of interest disclosures
Employment: University of Pennsylvania
Research funding: National Institutes of HealthPhilips HealthcareMedtronic Foundation
Consulting: Velomedix, Inc.HeartSine Technologies
Volunteer: American Heart Association
No equity or intellectual property related to resuscitation science
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What is cardiac arrest?
Electrical recordingof 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
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What is cardiac arrest?
Without any blood flow to the lungs or brain,
the victim of cardiac arrest is technicallydead and appears lifeless
(For brief minutes, may have gasping orseizure activity)
The immediate actions required to restoreblood flow:
1. Cardiopulmonary resuscitation (CPR)2. Electrical defibrillation
Both of these can be done by the lay public
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History of cardiopulmonary resuscitation (CPR)
Something like mouth-to-mouth in the Bible:Kings Chapter 2, Elijah treated a collapsed
childhe put his mouth upon [the childs]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 smokeinhalationfell out of practice in the 1800s
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Modern history of CPR and defibrillation
Drs. Knickerbocker, Kouwenhoven, and JudeJohns Hopkins, 1950sstudied defibrillationand chest compressions in the laboratory
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1961
A. Peter Safar, 1950smodernmouth-to-mouth
B. Early symposium on CPR
A B
Modern history of CPRventilations and putting it together
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Resuscitation and CPR in 2012
Consensus resuscitation guidelinesupdated every five years,published in the US by the American Heart Association
Worldwide training of CPR
Certification courses:BLS Basic Life SupportACLS Advanced Cardiovascular
Life Support
Training programs for using defibrillatorsVideo-based CPR trainingHands-only CPR (without mouth-to-mouth)
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Resuscitation and CPR in 2012
New directions in CPR:
Hands-only CPRevidencesuggests mouth-to-mouth maynot be required, especially forbystander response
New for 2010 guidelines:
Airway-Breathing-Circulationis now
Circulation-Airway-Breathing
CA B
. more on this in lecture 2
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Cardiac arrest and heart attack are not the same thing
A heart attack(myocardial infarction orMI)is from blockages in the coronary arteries,blood vessels that feed the heart
These blockages grow over years, relatedto genetic factors, smoking, hypertension,
and other risk factors
Normal
coronary
artery
Diseased coronary arteries
(coronary plaque)
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Cardiac arrest and heart attack are not the same thing
In a heart attack, a complete blockageleads to death of a portion of heart muscle
In most cases of heart attack, the victim livesand does not need CPR or defibrillation
Treatments for heart attack include:
aspirinangioplastycoronary stent placementanticoagulant medications
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Cardiac arrest compared to heart attack
Pathophysiology
Symptoms
Cardiac activity
Mortality
Treatment
Cardiac arrest Heart attack
Cardiac function Portion of heart muscleSuddenly stops starved of blood flow
Sudden collapse chest pain, nausea,shortness of breath
NO YES
Very high mortality low mortality
CPR, defibrillation aspirin, angioplasty
Recommended