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Cardiac resuscitation
Last reviewed: 07.07.2025
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Cardiac resuscitation has less favorable outcomes than pulmonary resuscitation, since when the heart stops, respiratory function also quickly ceases.
Signs of cardiac arrest are: absence of pulsation in the carotid arteries, total cyanosis of the body, dilated pupils, absence of reflexes, loss of consciousness, rapid cessation of spontaneous breathing.
Cardiac resuscitation, both at the pre-hospital and hospital levels, as a basic element, consists of closed cardiac massage (open cardiac massage is only permissible in operating rooms).
The main conditions for performing closed cardiac massage are: the patient's position on his back and on a hard surface; the position of the doctor's hands - the palm of the right hand in the lower third of the sternum, the fingers should be located along the fifth intercostal space on the left, the palm of the left hand is placed on top; prolapse is carried out with a sharp push to a depth of 6-8 cm at a frequency of 16-18 per minute. This ensures optimal blood flow, which is only 20-40% of the norm, but sufficient to support the life of the brain. Cardiac resuscitation with a deeper prolapse can be complicated by rib fractures, often with damage to the lungs and liver by bone fragments. More frequent massage leads to a decrease in blood flow.
When carrying out these measures, the doctor should periodically monitor the pulse on the carotid artery - its presence during the prolapse period indicates the effectiveness of the measures. Cardiac resuscitation is considered high-quality if there is a decrease in cyanosis, constriction of the pupils, the appearance of attempts at independent breathing and elements of consciousness.
Hospital cardiac resuscitation includes closed cardiac massage, pharmacotherapy and defibrillation. It is the main component of these measures, since defibrillation is ineffective in case of myocardial hypoxia.
Cardiac resuscitation must be combined with pharmacotherapy. Its goals are:
- relief of hypovolemic syndrome;
- elimination of acidosis;
- cardiac stimulation;
- defibrillation.
Defibrillation is performed only against the background of ongoing elimination of acidosis. If these conditions are not met, cardiac resuscitation is ineffective. Safety precautions must be strictly observed: dry hands, complete isolation from the patient and the table, with the registration and respiratory equipment turned off. Electrodes can be positioned in two ways:
- One is on the right in the second intercostal space, the second is in the region of the apex of the heart (fifth intercostal space on the left).
- The passive (flat electrode) is placed under the left shoulder blade, the active (on the insulating handle) - in the area of the apex of the heart.
The skin in the area where the electrodes are applied is degreased with alcohol, and gauze pads soaked in saline are placed underneath them. They should fit tightly to the patient's body. The current discharges are given in a cascade, increasing each discharge by 500 V. The massage is stopped only for the period of defibrillation. Pulmonary and cardiac resuscitation includes combined artificial ventilation and massage in a ratio of 1:4 (one breath - four prolapses).
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