Management of peri‐arrest arrhythmia

Abstract

104 Arrhythmias, potentially serious electrical abnormalities of the heart, cause most sudden cardiac death (SCD). Cardiac arrhythmias are a wellrecognised complication of myocardial infarction but can also be precipitated by metabolic or endocrine abnormalities or drugs (Table 1). They may precede ventricular fibrillation (VF) or follow successful defibrillation. Emergency cardiovascular care no longer focuses just on the patient in established cardiac arrest. Advanced life support (ALS) providers must be able to recognise promptly and effectively treat patients ‘on their way to a cardiac arrest’ and those recovering in the immediate post-resuscitation period. There are peri-arrest arrhythmia algorithms for: (i) broad complex tachycardia; (ii) narrow complex tachycardia; (iii) atrial fibrillation; and (iv) bradycardia. These algorithms, provided by the European Resuscitation Council (ERC) and adopted by the Resuscitation Council (UK), aim to facilitate the safe, effective and timely initial treatment of arrhythmias by the non-specialist ALS provider. They universally recommend seeking expert help expeditiously at various stages whilst assessment and life-saving first-line emergency treatment is undertaken. They also clearly re-assure the non-specialist and outline recommendations in case of non-life-threatening arrhythmias.