Description

• The absence of effective mechanical cardiac activity leading to tissue hypoperfusion and cell death
• This section is not a substitute for an American Heart Association (AHA)-approved advanced cardiac life support (ACLS) course and is intended only as a quick reference.
• Synonym(s): “Code” or “Code Blue”

Geriatric Considerations
It is important to have an open dialogue with patients regarding their code status, that is, do not resuscitate (DNR) and/or do not intubate (DNI) orders.

Pediatric Considerations
Asphyxia is the most common precipitant of cardiac arrest in children due to hypoxia and hypercapnia. Impending arrest is often heralded by bradycardia.

Pregnancy Considerations

• Left uterine displacement in combination with chest compressions can best be accomplished by placing the patient on a hard surface and manually pulling the uterus to the patient’s left and upward. This allows increased blood return to the heart. Consensus guidelines have a standard of 5 minutes for fetal delivery from emergency C-section in those patients unresponsive to cardiopulmonary resuscitation (CPR) (1)[C]. Delivery may be lifesaving for fetus and mother.
• Consider amniotic fluid embolism, eclampsia-related seizures, or flash pulmonary edema as precipitating factors.

Epidemiology

• Predominant age: Risk increases with age.
• Predominant sex: male > female

Incidence
0.5 to 1.5/1,000 persons per year

Etiology and Pathophysiology

• Asystole (confirm in two leads)
• Ventricular fibrillation (VF)
• Pulseless ventricular tachycardia (VT)
• Pulseless electrical activity (PEA)
• Consider possible reversible causes (6 Hs and 5 Ts):
  • Hypoxia, hypovolemia, hyper- and hypokalemia, (H⁺) (acidosis), hypothermia, hypoglycemia
  • Cardiac tamponade, tension pneumothorax, thrombosis (pulmonary embolism, coronary), toxins (medications and overdoses), trauma

Risk Factors

• Male gender
• Advanced age
• Hypercholesterolemia
• Hypertension (HTN)
• Cigarette smoking
• Diabetes
• Cardiomyopathy
• Coronary artery disease
• Prolonged QT

Commonly Associated Conditions

• Coronary artery disease/acute coronary syndrome (ACS)
• Valvular heart disease
• Pulmonary embolism