Singap Med J
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There is a need to establish a National Sudden Cardiac Arrest registry that would track the performance and outcomes of out-of-hospital (OHCA) and in-hospital cardiac arrests (IHCA) in the country. An effective strategy to improve survival from sudden cardiac arrest in Singapore requires a multi-pronged effort targeting the community, Emergency Medical Services (EMS) and the hospitals. The establishment of such a registry is important, as it would enable the tracking of trends and effectiveness of subsequent interventions related to our national strategy for management of both OHCA and IHCA. ⋯ A key part of this process is data collection. A cardiac arrest registry can be a key tool for quality improvement and serves as an important foundation on which to implement and track planned improvements to cardiac arrest management both in and out of hospital. It would also aid in planning for deployment of resources, interventions and ongoing efforts to improve Singapore's EMS.
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The core skills required in resuscitation of cardiac arrest individuals is referred to as Basic Cardiac Life Support or cardiopulmonary resuscitation (CPR). Once cardiac arrest (an unresponsive patient with no breathing or only gasping motions) is recognised, chest compressions should be initiated. Healthcare workers may choose to also check for a pulse to verify cardiac arrest if they are trained. ⋯ Every 30 chest compressions should be followed promptly by two quick and short ventilations (each 400-600 ml tidal volume) delivered within six seconds. Chest compression-only CPR is recommended for dispatcher-instructed CPR or if the rescuer, for any reason, is unable or unwilling to do mouth-tomouth ventilations. CPR should only be stopped when the patient wakes up or an emergency team arrives and takes over patient care, or if an automated external defibrillator were to prompt interruption of chest compressions for analysis of heart rhythm or delivery of shock.
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Following restoration of pulse after the institution of cardiopulmonary resuscitation, defibrillation and perhaps, the initial resuscitative drugs, there is a greater challenge of maintaining that heartbeat for at least the next 24 hours, which can better ensure a high likelihood of the patient being discharged alive from the hospital. A bundle of procedures, which may need to be administered simultaneously, is required. These include prompt identification and treatment of the cause of cardiac arrest, with early consideration for procedures such as percutaneous coronary interventions and fibrinolytics, and treatment of electrolyte abnormalities. ⋯ Additional benefit is possible with appropriate forms of early goal-directed therapy and achieving therapeutic hypothermia within the first few hours, followed by gradual rewarming and ensuring glycaemic control by maintaining blood sugars within a range of 6-10 mmol /L. All these would be important and need to be continued for at least 24 hours, together with a series of measures to control neurological reactions and monitor neurological responses for best effect. Creation of a bundle that incorporates these various aspects of care would more likely ensure that most patients who achieve return of spontaneous circulation may be discharged alive from the hospital with optimal neurological function.
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Cardiac arrest occurring on board aeroplanes is rare, but remains a common cause of inflight incidents. This review examines some of the management problems unique to inflight cardiac arrests, and emphasises the use of cardiopulmonary resuscitation and automated external defibrillators.
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Drug therapy is recommended after effective cardiopulmonary resuscitation and defibrillation in cardiac arrest. Some drugs appear to have short-term benefits, such as improved survival to hospital, e.g. vasopressor and antiarrhythmics. Hence, they have been included in the cardiac life support algorithm. ⋯ This review is an update on drugs during resuscitation, including the choice of agents, dosing, sequence and route. Specific drugs may have benefits in correcting identified causes of collapse. Drug usage during resuscitation is an evolving science, with the use of medications improving as results of clinical studies become available.