Summary
Definition
Esta monografía incluye el paro cardíaco en adultos. El paro cardíaco repentino es un estado repentino de insuficiencia circulatoria debido a una pérdida de la función sistólica cardíaca. Es el resultado de 4 alteraciones específicas del ritmo cardíaco: fibrilación ventricular (FV), taquicardia ventricular sin pulso, actividad eléctrica sin pulso y asistolia. ""Torsades de pointes es un subgrupo de TV polimórfica en pacientes con intervalo QT prolongado subyacente, algunas veces asociado a hipomagnesemia.[Figure caption and citation for the preceding image starts]: Taquicardia ventricular monomórficaDe las colecciones personales de los Dres. A. Askari y A. Krishnaswamy; usado con autorización [Citation ends].
[Figure caption and citation for the preceding image starts]: Torsades de pointesDe la colección personal del Dr. A. Askari; usado con autorización [Citation ends].
History and exam
Key diagnostic factors
- paciente inconsciente
- ausencia de respiración normal
- ausencia de circulación
- alteración del ritmo cardíaco
Risk factors
- arteriopatía coronaria (AC)
- disfunción ventricular izquierda
- edad
- cardiomiopatía hipertrófica (CMH)
- displasia ventricular derecha arritmogénica (ARVD)
- síndrome del segmento QT largo (SQTL)
- medicamentos que prolongan el intervalo QT o que provocan alteraciones electrolíticas
- emergencia médica o quirúrgica aguda
- envenenamiento
- síndrome de Brugada
- cardiopatía valvular
- tabaquismo
- antecedentes de trastornos de la alimentación
Diagnostic investigations
1st investigations to order
- monitorización cardíaca continua
- hemograma completo (HC)
- electrolitos séricos
- GSA
- biomarcadores cardíacos
- ecografía en el punto de atención (POCUS)
Investigations to consider
- electrocardiograma (ECG)
- angiografía coronaria
- ecocardiograma
- pruebas de esfuerzo con ejercicio
- radiografía de tórax
- cribado toxicológico
- resonancia magnética cardíaca
- angiografía coronaria por tomografía computarizada
- electrocardiograma de señal promediada (SAECG)
- estudio electrofisiológico
Treatment algorithm
paro cardíaco no presenciado
ritmos que se pueden tratar con choque eléctrico (taquicardia ventricular sin pulso o fibrilación ventricular)
ritmos que no se pueden tratar con choque eléctrico (actividad eléctrica sin pulso o asistolia)
regreso de la circulación espontánea
ausencia de regreso de la circulación espontánea
Contributors
Authors
John Wink, MD
Emergency Physician
Alberta Health Services
Alberta
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 Oct 20;142(16_suppl_2):S366-468.Full text Abstract
Martin SS, Aday AW, Almarzooq ZI, et al. 2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024 Feb 20;149(8):e347-913.Full text Abstract
Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022 Oct 21;43(40):3997-4126.Full text Abstract
Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Circulation. 2018 Sep 25;138(13):e272-391.Full text Abstract
Greif R, Bray JE, Djärv T, et al. 2024 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces. Resuscitation. 2024 Dec;205:110414.Full text Abstract
Nolan JP, Sandroni C, Böttiger BW, et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Resuscitation. 2021 Apr;161:220-69.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Guidelines
- Critical care management of patients after cardiac arrest: a scientific statement from the American Heart Association and Neurocritical Care Society
- 2024 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
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