Textbook of Emergency Cardiology

 Textbook of Emergency Cardiology 2021




We have been privileged to put together a state-of-the-art book called “Textbook of Emergency Cardiology.” For this
we assembled a team of co-authors that are superb researchers, clinicians, and teachers in the fields of cardiology
and emergency medicine.

This ensures that the readers will get a solid exposure with regard to current conceptsinpathogenesis, diagnosis, and treatment of every cardiovascular emergency that “rolls into the emergency department
or hospital.” Thus, from medical or nursing student, to the intern or resident or fellow, and through to an experienced
staff attending physician, this book should become a useful tool for everyday medical use.






Cardiac arrest has been defined as the cessation of cardiac
echanical activity confirmed by the absence of signs of

Any arrest in an adult is presumed to be of
cardiac etiology unless it is known, or likely to have been
caused by another noncardiac cause as best determined
by the healthcare provider.1
Despite important advances in prevention, cardiac
arrest continues to affect thousands of individuals each
year in both the prehospital and hospital environment.
The American Heart Association (AHA) estimates that
there were 359,400 adult out-of-hospital cardiac arrests
(OHCA) in 2013, with an overall survival rate of 9.5%.
This contrasts with the incidence of in-hospital cardiac
arrest (IHCA) with an incidence of 209,000 in 2013 and
a survival rate of 23.9% in adults.2 This chapter reviews
key components of adult cardiac resuscitation in the
prehospital and hospital setting.



Emergency medical service (EMS) response to cardiac
arrest usually begins with a layperson in the community
and ends with the transfer of the patient to an emergency

Over the last three decades, public health
initiatives have attempted to improve the outcomes for

These efforts have focused on layperson education
and recognition early activation of EMS, improving access
to automated external defibrillation devices [automated external defibrillator (AED)]and increasing public edu-cation in cardiopulmonary resuscitation (CPR).3,4 Dueto these efforts, according to the AHA’s update report in
2013, 79% of the lay public were confident that they knew what actions to take in a medical emergency, 98% recog-nized the function of an AED and 60% were familiar withCPR.2Despite the general public familiarity with CPR and
AEDs, several studies have shown that the translation of
this knowledge into practice remains poor.5-7 This is of
particular importance as the majority of OHCA occur ata patient’s home, and less than half of these arrests arewitnessed by bystanders.8
One of the primary responsibilities of a layperson first
responder is to call 911 and activate EMS immediately.
Depending on the type of dispatch center contacted,
there may be a trained EMS dispatcher who is able to
provide bystanders with instructions prior to the arrival of
an ambulance.

Dispatchers are able to assist nontrained
bystanders with recognizing cardiac arrest, providing CPR
instructions and aiding with the location of an AED.

Theguidance provided by EMS dispatchers has been shown
to nearly double the rate of bystander CPR.9
It is important to recognize that EMS providers have
different levels of training and capabilities when treating
patients following OHCA.

Although differentiatingbetween the various training levels of emergency medical
technicians (EMTs) is not the focus of this chapter, medical
providers should be aware that EMS systems will vary
in the scope of life-saving interventions they are able to

These prehospital medical services will include a
combination of basic life support (BLS), advanced cardiac
life support (ACLS) and advanced airway management.10
The level of training and care provided in the prehospital
setting may have an impact on patient outcomes.

Bakaloset al.performed a meta-analysis in 2011 comparing BLS
and ACLS and showed an increase in survival for cardiac
arrest patients who received ACLS level care in the
prehospital setting [odds ratio (OR) = 1.47].11
Patient age, gender, initial cardiac rhythm, bystander
CPR, and early defibrillation are all variables known
to impact outcomes in out-of-hospital cardiac arrest.12
A patient’s socioeconomic status may also have an
influence on outcomes.

Vaillancourt et al. showed an
association between socioeconomic status and rates of
bystander CPR, with decreased likeliness of receiving
bystander CPR associated with lower socioeconomic
status.13 In addition, a large emphasis has been placed
on EMS scene response time for patients with OHCA.
This emphasis is appropriate for patients experiencing
OHCA due to association between survival rates and the
time to arrive by EMS.14 Even in the setting of a bystander .





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