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Cardiopulmonary
resuscitation (CPR)
1993-2018
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Nhrc : Twenty Five Years-billion Hopes
98. What should be the minimum duration for which a person should
be resuscitated before death declaration?
CPR discontinuation should be based on clinical condition of the
patient. Once the reversible causes have been ruled out and/or
corrected, based on clinical judgment and a careful assessment, a
decision may be taken to discontinue CPR. The presence of rhythm
such as Ventricular Fibrillation/pulse less Ventricular Tachycardia
should prompt to continue the resuscitation attempts. End tidal
Carbon dioxide (EtCO2) has been suggested a good sign of perfusion
and thus can be used for prognostication in intubated patients. It may
be suggested that with high-quality CPR and rhythm as asystole for >20
min, EtCO2 <10 mmHg may be considered a sign to forgo further
attempts. In patients without such monitoring, a de inite time frame is
not suggested and duration should be based on clinical decision. The
inal decision to start and stop resuscitation would also be based on the
overall clinical assessment. So it can be concluded that if the heart is
still not beating even after a good CPR, the effort for CPR should be at
least of more than 20 minutes duration in any case.
99. What are the common causes which could lead to cardiac arrest
requiring assessment and management for an optimal outcome after
CPR?
The more common causes requiring assessment and management can
be remembered with the mnemonic 'HIT THE TARGET' (H – Hypoxia, I
– Increased H Ions [Acidosis], T–Tension Pneumothorax, T–
Toxins/Poisons, H – Hypovolaemia, E – Electrolyte Imbalance [Hypo/Hyperkalaemia], T –Tamponade Cardiac, A – Acute Coronary
Syndrome, R–Raised Intracranial Pressure [Subarachnoid
Haemorrhage], G – Glucose [Hypo-/hyperglycaemia], E–Embolism
(Pulmonary Thrombosis), T–Temperature [Hypothermia]). In a
hospital setting, many other cardiac and non-cardiac causes could also
lead to cardiac arrest and should also be sought based on pre-existing
clinical diagnosis, history, clinical signs and appropriate investigations.
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