MANAGEMENT OF CARDIOPULMONARY ARREST (CPA) IN THE EMERGENCY DEPARTMENT
DOI:
https://doi.org/10.63330/aurumpub.012-018Keywords:
Cardiac arrest, Cardiopulmonary resuscitation, Spontaneous circulation, Basic life support, EmergencyAbstract
The management of cardiopulmonary arrest (CPA) in an emergency is a critical situation that requires rapid and coordinated action. Survival depends on the speed and efficiency of interventions, following established protocols based on scientific evidence. Successful care begins with early identification of CPA, characterized by the absence of a pulse and effective breathing. The sequence of actions begins with the immediate activation of the emergency response system (calling 911, for example), communicating the situation and location of the victim. Simultaneously, basic cardiopulmonary resuscitation (CPR) is initiated, consisting of effective chest compressions and rescue ventilations. The depth of compressions should be at least 5 cm, with a frequency of 100-120 per minute, minimizing interruptions. The compression-to-ventilation ratio in adults is 30:2. Upon arrival of advanced life support (ALS), the medical team takes control, establishing venous access for the administration of medications and fluids. Electrocardiographic (ECG) monitoring is essential to identify the heart rhythm and guide treatment. Defibrillation, when indicated (ventricular fibrillation or pulseless ventricular tachycardia), is a crucial intervention to restore normal heart rhythm. Adrenaline, amiodarone, and other drugs are administered according to the detected rhythm and current guidelines. Endotracheal intubation secures the airway, allowing mechanical ventilation and oxygen administration. Continuous monitoring of vital signs, including blood pressure, heart rate, oxygen saturation, and capnography, is essential to assess response to treatment. After return of spontaneous circulation (ROSC), care should focus on hemodynamic stabilization, prevention of complications, and identification of the underlying cause of CPR. Therapeutic hypothermia, in selected cases, may improve neurological prognosis. Post-CPR resuscitation includes ventilatory support, continuous cardiac monitoring, glucose control, and management of possible complications such as arrhythmias and organ dysfunction. Careful neurological assessment and rehabilitation are important for long-term recovery. Educating the population about basic CPR is essential to increase the chances of survival in cases of cardiac arrest. Teamwork, effective communication, and ongoing training are essential for the successful management of cardiac arrest in the emergency setting.
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References
Gonzalez MM, Timerman S, Gianotto-Oliveira R, Polastri TF, Canesin MF, Schimidt A ,et al. Sociedade Brasileira de Cardiologia. I Diretriz de Ressuscitacão Cardiopulmonar e Cuidados Cardiovasculares de
Emergência da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol. 2013;101(2 Supl 3):1-221.
Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015 Oct;95:1-80
Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. Part 1: executive summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S315-367.
Zipes DP, Libby P, Bonow OR, Mann DL, Tomaselli GF. Braunwald’s heart disease: a textbook of cardiovascular medicine. 9th ed. Rio de Janeiro: Saunders/ Elsevier;2011.
Brasil. Ministério da Saude. Departamento de Informática do SUS – Datasus. [on-line]. Brasília (DF). Disponível em: [Citado em 2016 jun 10] Disponível em : http://www2.datasus.gov.br» http://www2.datasus.gov.br
Chan OS, McNally B, Tang F, Kellermann A. CARES Surveillance Group. Recent trends in survival from out-of-hospital cardiac arrest in the United States. Circulation. 2014; 130(21):1876-82.
Lai H, Choong CV, Fook-Chong S, Ng YY, Finkelstein EA, Haaland B, et al. PAROS study group. Interventional strategies associated with improvements in survival for out-of-hospital cardiac arrests in Singapore over 10 years. Resuscitation. 2015 Apr;89:155-61.
Cobb LA, Fahrenbruch CE, Olsufka M, Copass MK. Changing incidence of out-of-hospital ventricular fibrillation, 1980-2000. JAMA. 2002; 288(23):3008-13.
Agarwal DA, Hess EP, Atkinson EJ, White RD. Ventricular fibrillation in Rochester, Minnesota: experience over 18 years. Resuscitation. 2009;80(11):1253-8.
Rea TD, Olsufka M, Bemis B, White L, Yin L, Becker L, et al. A population- based investigation of public access defibrillation: role of emergency medical services care. Resuscitation. 2010;81(2):163-7.
Ildris AH, Guffey D, Pepe PE, Brown SP, Brooks SC, Callaway CW, et al. Resuscitation Outcomes Consortium Investigators. Chest compression rates and survival following out-of-hospital cardiac arrest. Crit Care Med. 2015;43(4):840-8.
Vadeboncoeur T, Stolz U, Panchal A, Silver A, Venuti M, Tobin J, et al. Resuscitation. 2014;85(2):182-8.
Bohn A, Weber TP, Wecker S, Harding U, Osada N, Van Aken H, et al. The addition of voice prompts to audiovisual feedback and debriefing does not modify CPR quality or outcomes in out of hospital cardiac arrest-a prospective, randomized trial. Resuscitation. 2011;82(3):257-62.
Glatz AC, Nishisaki A, Niles DE, Hanna BD, Eilevstjonn J, Diaz LK, et al. Sternal wall pressure comparable to leaning during CPR impacts intrathoracic pressure and haemodynamics in anaesthetized children during cardiac catheterization. Resuscitation. 2013;84(12):1674-9
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Copyright (c) 2025 Vanessa Batista Pereira, Antônio de Medeiros Pereira Filho, Marcos Paulo Parente Araújo, Máira Santiago Pires Parente, Ilana Azevedo de Amorim, Maria dos Passos Unida (Autor)
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