Next, advanced life support measures are used, including intravenous or intraosseous medication administration. If return of spontaneous circulation (ROSC) is obtained, the patient cardiac arrest causes and risk factors will undergo post-resuscitation care with subsequent long-term management. Emergency treatment for sudden cardiac arrest includes cardiopulmonary resuscitation (CPR) and shocks to the heart with a device called an automated external defibrillator (AED). Since most SCDs occur in the home, the Home Automated External Defibrillator Trial119 was performed to assess whether AED placement at homes of individuals who are at increased risk of SCD would save lives. About 7,000 patients with prior MI who were not candidates for an ICD were randomly assigned to have an AED in their home or to control response (calling the emergency medical services and performing CPR; both groups were trained in this response) in case of a cardiac arrest. However, there is no reason why a strategy of AED use in the home should not work, when there is a willingness to use these devices in the household of the individual at risk.
Wearable technology and electronics embedded in clothing is a new and potentially feasible option to detect cardiac arrest and trigger a response. The majority of SCD cases occur outside of hospital settings, and the survival rate of out-of-hospital cardiac arrest in China is low, remaining at approximately 2% 15,16,17, 56, 57. Several contributing factors, including insufficient primary prevention, poor public knowledge, and awareness of proper responses during sudden cardiac events and capacity constraints in existing prehospital emergency systems, have been reported 14, 58. Our research results also indicated that the accessibility of medical resources is an important factor affecting SCD (Table 2). Notably, ischemic heart disease, the leading cause of SCD, is currently effectively managed in clinical practice. Owing to the increased utilization of reperfusion therapies such as percutaneous coronary intervention and coronary artery bypass grafting, acute myocardial infarction patients exhibited favorable outcomes 59, 60.
AEDs education and availability have greatly changed our approach to reviving out-of-hospital cardiac arrest patients regardless of their pre-existing health status and currently form the cornerstone of CPR and advanced life support protocols 19. Regrettably, the coverage of AEDs is generally low in some areas in China, and the placement of AEDs lacks strategic planning 27, 29, 64, 65. Although progress has been made in recent years in some provinces, such as Hangzhou, Shanghai, Shenzhen, and Haikou, the implementation of SCD prevention policies remains in the early phases and is not optimal in other regions of China 27, 66. In 2016, the 525+ project was launched to promote CPR training and awareness. Since its inception, 177 training centers have been established, showing notable progress.
Symptoms of Cardiac Arrest
Whenever there was uncertainty about a potential eligible study, the senior author (LJM) provided an additional review to verify selected full texts, and final decisions were achieved by discussion and consensus. The primary author reviewed the final selected articles multiple times to ensure the accurate selection. The sociodemographic information included gender (male or female), age (0–14 years, 15–34 years, 35–64 years, and ≥ 65 years), marital status (unmarried, married, widowed, or divorced), location (urban or rural), and region (Eastern, Middle, or Western).
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The aim of this scoping review is to explore all relevant published research to identify the current state of reported OHCA outcome based on each confirmed etiology compared with “presumed cardiac” (Utstein 2004) or “medical” (Utstein 2015) etiologies. Outcomes of interest will include standard outcomes such as return of spontaneous circulation (ROSC), admission to hospital, discharge from hospital, and favorable neurological outcomes. This scoping review will also investigate the reported survival outcome of OHCA by the etiology following prehospital cause-targeted interventions. The scoping review was considered the most appropriate method because the evidence was anticipated to be diverse and indirect 18. There is an urgent need to intensify existing interventions, including strengthening public knowledge and awareness of emergency response and expanding AEDs placement, CPR and basic life support training.
A family history of cardiac disease is a well-established risk factor for cardiac arrest. A family history of sudden cardiac death raises a person’s own risk for a fatal arrhythmia in both men and women. However, the strength of the association is much larger for cardiac arrest in women, as family history bears greater weight in the susceptibility of women (L A Smits et al., 2022). Familial aggregation studies, which often rely on relatives of individuals with disease, have convincingly demonstrated that prevalence rates of cardiac arrest are elevated among family members of individuals with such events. Their findings in proband investigations convincingly link a family history of cardiac events – heart attacks, high blood cholesterol levels, and hypertension – to a markedly increased susceptibility to similar events.
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This condition can have a significant impact on the structure of the heart as well as its function and electrical system. This condition is characterized by a rapid heartbeat within the heart’s ventricles, which hinders its ability to pump blood effectively. Temporal trends in in-hospital and out-of-hospital cardiovascular mortality among men and women living in Minneapolis–St Paul, MN, USA.
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Injuries accounted for a relatively small portion (14.6%) of EDCA cases. The mean hospital length of stay was about eight days with nearly 70% of the hospitalized EDCA patients surviving until discharge. In many patients, warning symptoms may precede a cardiac arrest. However, many times these symptoms are unrecognized or ignored by the individual.7 Many patients who survive cardiac arrest have amnesia, not allowing for the recollection of symptoms before an event. Data obtained from those who did not have amnesia, from family members and/or from those who witnessed the event shows that the most common symptom was chest pain.7 Appropriately, this mirrors the most common presentations of acute coronary ischemia.
Thus, including a mix of etiologies within a cohort of patients may affect the reported outcomes in either direction. The stochastic nature (randomness) of sudden cardiac arrest is in some aspects similar to acute coronary syndromes. An acute coronary syndrome is the result of a perfect storm scenario, where disruption of an atherosclerotic plaque coincides with a pro-thrombogenic moment in thrombocytes, coagulation factors, endothelial function, etc. The perfect storm implies that plaque disruption occurs when pro-thrombogenic factors outweigh pro-thrombolytic factors. The balance between pro-thrombogenic and pro-thrombolytic factors determines whether atherothrombosis occurs, and these factors vary from minute to minute.
- This is because cholesterol forms plaque in the arteries, which can harden and narrow these vessels, which in turn diminishes blood flow to the heart.
- Medical cardiac arrest patients are treated with ALS as discussed above.
- The population was limited to adult patients (as defined in each paper) who had experienced OHCA and were treated by emergency medical services (EMS) providers and for whom the initial diagnosis was assigned.
- In particular, a large proportion of cardiac arrests were reported outside of hospitals, making it difficult to verify the actual cause of death and introducing potential errors.
In addition, for other high-risk SCD patients with comorbid CVDs, valve surgeries play an essential role in preventing SCD by restoring normal valve function and improving cardiac hemodynamics. In China, although the application of these surgeries has increased, the prevention and treatment of SCD after revascularization remain relatively inadequate at present. ICDs have become important procedures for both primary and secondary prevention of SCD. However, despite their proven efficacy 61, 62, ICD utilization remains suboptimal worldwide. In China, the implantation rates of ICD are substantially low 26, 63.
- Sudden cardiac arrest is the most lethal manifestation of cardiovascular disease, accounting for 50% of all cardiovascular deaths (Tsao et al).
- It can lead to heart conditions such as hypertrophy, CAD, heart attack, and heart failure.
- Consistent patient cohorts by etiology may make the reported results more comparable across different registries.
- ICDs are small devices that deliver electrical shocks to the heart to control arrhythmias.
Causes and risk factors for sudden cardiac arrest
If ROSC is obtained after a medical cardiac arrest, the emergency room physician will call upon the intensive care team to take care of the patient. If the medical cardiac arrest is deemed secondary to a primary cardiac etiology, cardiology should be consulted to see what intervention is appropriate. Certain heart conditions and health factors can increase your risk of cardiac arrest. The Institute of Medicine reports that every year, more than half a million people experience cardiac arrest in the United States. If you or someone you’re with is experiencing symptoms of cardiac arrest, seek emergency health assistance immediately.
The only way to know whether you have high blood pressure is to measure your blood pressure. You can lower your blood pressure with lifestyle changes or with medicine to reduce your risk for heart disease and heart attack. Some risk factors for heart disease cannot be controlled, such as your age or family history. But you can take steps to lower your risk by changing the factors you can control. Patients with confirmed ICH had poor survival to hospital discharge with poor neurological recovery compared with non-ICH etiologies 46.
Regular physical activity can lower your risk for heart disease. Globally, there is significant variation in the burden of SCD; however, such data for low- and middle-income countries are sparse. In addition to variations in estimated mortality, there are also differences in underlying causes, with ischaemic heart disease (IHD) accounting for up to two thirds of deaths in high-income countries, but only one third in the African and South-East Asian regions. To support the development of preventive strategies, information on both the extent and nature of the problem is needed.