Cardiac arrest

Last reviewed: 25 Aug 2023
Last updated: 22 Dec 2022

Summary

Definition

History and exam

Key diagnostic factors

  • patient unresponsive
  • absence of normal breathing
  • absence of circulation
  • cardiac rhythm disturbance
More key diagnostic factors

Risk factors

  • coronary artery disease (CAD)
  • left ventricular dysfunction
  • hypertrophic cardiomyopathy (HCM)
  • arrhythmogenic right ventricular dysplasia (ARVD)
  • long QT syndrome (LQTS)
  • medications that prolong the QT interval or cause electrolyte disturbances
  • acute medical or surgical emergency
  • illicit substances
  • Brugada syndrome
  • valvular heart disease
  • smoking
  • history of eating disorders
More risk factors

Diagnostic investigations

1st investigations to order

  • continuous cardiac monitoring
  • CBC
  • serum electrolytes
  • ABG
  • cardiac biomarkers
  • point of care ultrasound (POCUS)
More 1st investigations to order

Investigations to consider

  • ECG
  • coronary angiography
  • echocardiogram
  • chest x-ray
  • toxicology screen
  • cardiac magnetic resonance imaging
  • coronary computed tomography angiography
  • signal-averaged ECG (SAECG)
  • electrophysiologic study
More investigations to consider

Treatment algorithm

INITIAL

unwitnessed cardiac arrest

ACUTE

shockable rhythms (pulseless ventricular tachycardia or ventricular fibrillation)

nonshockable rhythms (pulseless electrical activity or asystole)

ONGOING

return of spontaneous circulation

no return of spontaneous circulation

Contributors

Authors

John Wink, MD

Resident Physician

Department of Emergency Medicine

University of Calgary

Calgary

Canada

Disclosures

JW declares that he has no competing interests.

Eddy Lang, MD

Professor and Department Head of Emergency Medicine

Cumming School of Medicine

University of Calgary

Alberta Health Services

Calgary

Canada

Disclosures

EL declares that he has no competing interests.

Acknowledgements

Dr John Wink and Professor Eddy Lang would like to gratefully acknowledge Dr Amar Krishnaswamy and Dr Arman T. Askari, previous contributors to this topic.

Disclosures

AK and ATA declare that they have no competing interests.

Peer reviewers

Vaikom Mahadevan, MD

Professor of Medicine

Division of Cardiology

University of California

San Francisco

CA

Disclosures

VM declares that he has no competing interests.

Anthony Aizer, MD, MS

Instructor

NYU Department of Medicine (Cardiology)

Leon H Charney Heart Rhythm Center and New York University

New York

NY

Disclosures

AA declares that he has no competing interests.

Massimo F. Piepoli, MD, PhD, FESC

Honorary Clinical Senior Lecturer/Consultant

Department of Cardiology

Imperial College London

London

UK

Disclosures

MFP declares that he has no competing interests.

  • Cardiac arrest images
  • Guidelines

    • 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death
    • 2022 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendation
    More Guidelines
  • Patient leaflets

    Heart attack: what is it?

    Bag-valve-mask ventilation

    More Patient leaflets
  • Videos

    Radial artery puncture animated demonstration

    Femoral artery puncture animated demonstration

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer