Talk:Cardiac arrest/Archive 1

2005-2006

Is the picture of the ambulance really necessary to the article? It doesn't really have a huge deal to do with the topic.

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I think there is a slight difference between "clinical death" and "cardiac arrest".
Cardiac arrest inevitably leads to clinical death but clinical death is the period when circulation ceases and oxygen etc supply is cut from vitally important tissues, namely brain and heart muscle. The consequence is shift into anaerobic metabolism, acidosis and cell disintegraton.
This period is variable and depends on many factors for instance age and surroundings temperature.
There have been examples of successful resuscitation of people drowned for half and hour in ice-cold water.

I agree.

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Anyone care to have a look at the "Ethical Issues" section? While the author seems to have tried to advance a possibly valid point (that of terminal patients not willing to prolonge their suffering), the way it is currently written kind of seems to imply that one should not provide emergency care to an arrested patient because of the risk of (non-serious, given the circumstances) injury or pain.--81.42.163.238 01:14, 20 Apr 2005 (UTC)

Make it simple

Isn't this basically when the heart stops beating? If so, please include that in the intro sentence. Twilight Realm 00:00, 3 November 2005 (UTC)

Ah, if but it were! A cessation of heartbeat is a type of cardiac arrest (known as asystole or PEA), but there are other types of cardiac arrest where the heart doesn't stop (VFib/VTach). In all cases of cardiac arrest, the carotid pulse is absent, but there are other conditions (hypovolaemia being one) where the pulse may be absent but the heart beating. The best definition is of an inneffective heart beat, but even that produces problems - sinus rhythm is the only heart rhythm which is optimally effective, so where do you draw the line? Atrial Fibrillation is not a totally effective heart beat, but neither is it a cardiac arrest. I think that medically, the definition given on the page is about as good as we're likely to get, even if it is a little long winded. --John24601 16:20, 7 January 2006 (UTC)

Causes of arrest

I don't know why it was changed from 4H/4Ts... that is the commonly accepted list in the UK at least, and is published by the UK resuscitation council. Acidosis from Hydrogen ions comes under hypo/hyper metabolic causes; and the two thromboses are dealt with together. I've changed the article back to reflect this. --John24601 12:56, 8 January 2006 (UTC)

Cardiogenic Shock

Have reverted edits by User:Nescio which deleted the page and reverted it to cardiogenic shock. Please don't do it again - alot of us have put alot of hard work into this page, we don't want to see it subsumed into another (irrelevant) topic without even so much as a discussion. Cardiac Arrest is not the same thing as cardiogenic shock.--John24601 07:32, 30 March 2006 (UTC)

Although I appreciate many have done alot of work, and I should have discussed this, much of what is mentioned is chaotic, incorrect, or irrelevant. Cardiac arrest means no circulation, and that is what cardiogenic shock is. It is not equivalent to sinus arrest: the lack of electrical activity from the sinus node. Furthermore, all causes that are mentioned in the article you want to preserve, describe shock. Maybe you could point out the difference between cardiac arrest and cardiogenic shock. Technically (semantics) arrest rapidly (sec-min) transforms into shock. However, that is no reason not to discuss the conditions in the same article, i.e. merge.

As the two terms describe the same situation, rapid depletion of oxygen in vital organs due to inadequate cardiac function, I'll have to revert. Nomen Nescio 12:59, 30 March 2006 (UTC)

Errr... no. Cardiac arrest is not cardiogenic shock. Cardiac Arrest is a cessation of any circulation (although not nescessarily a stoppage of the heart); Cardiogenic shock is one condition where there may be a undereffective circulation. Cardiogenic shock may lead to cardiac arrest, but so may alot of other things. Comments anyone? --John24601 14:43, 30 March 2006 (UTC)

Elaborate please:

Cardiac Arrest is a cessation of any circulation. This is circulatory arrest is it not?

Cardiogenic shock is one condition where there may be a undereffective circulation. From Irwin and Rippe:

In cardiogenic shock, the underlying defect is primary pump failure. The causes ... include: (a) myocardial infarction .... (b) .... cardiomyopathy (c) ventricular outflow obstruction [AoS, aortic dissection] (d) ventricular filling anomalies (atrial myxoma, mitral stenosis) (e) acute valvular failure ...(f) cardiac dysrhythmias (g) ventriculoseptal defects.

This constitutes circulatory arrest and insufficient circulation does it not?

As I pointed out semantics-wise there is a difference but they are very similar and the current form I think explains that. At least it does not warrant two articles. Nomen Nescio 15:11, 30 March 2006 (UTC)

I think I see where we're getting wires crossed here - you're not a native english speaker. In english, Cardiac Arrest is what you are referring to as Circulatory arrest (I guess). It's not the same thing as cardiogenic shock. If others are in agrrement I'll revert again. --John24601 15:30, 30 March 2006 (UTC)

Before reverting, could you please read the current article to see if what you are saying is not already addressed? IMHO, we have two articles discussing the same. In other words, could you explain the difference between arrest and shock to a non-native? Nomen Nescio 15:36, 30 March 2006 (UTC)

Cardiogenic Shock = shock which is cardiac in origin (eg/ could be a result of cardiomyopathy, left ventricular failure, large accute MI). Shock (of which there are many types - the most common being cardiogenic and hypovolemic [diminished circulating volume ie/ after bleeding or burn]) is a condition where there is inneffective perfusion of the tissues, resulting in a mechanism to try and raise the blood pressure. A Cardiac arrest is a sudden cessation of cardiac function (ie/ it either stops [Asystole or PEA] or it goes but fails to pump blood because of its speed/rhythm [VF/VT]), which is treated with (amongst other things) CPR, Intubation, Defibrillation, and consideration of the reversible causes (Which were listed on the page - Hypoxia, Hypovolaemia, Hypothermia, Hypo/Hyper-metabolics, Toxins, Tension Pneumothorax, Tamponade or Thrombosis). They are most definitely not the same thing (although of course cardiogenic shock has the potential to degenerate into cardiac arrest).—Preceding unsigned comment added by John24601 (talk • contribs)

At the risk of being stubborn, Irwin and Rippe is my guide and I quoted it above. You'll notice that Asystole or PEA (dysrhythmias) are mentioned as cause of cardiogenic shock. Furthermore, inneffective perfusion of the tissues is seen in shock and in cardiac arrest. Please read the well-referenced shock for a better understanding of all the conditions you name as cause of cardiac arrest.

Regarding, although of course cardiogenic shock has the potential to degenerate into cardiac arrest, shock through hypoperfusion may cause cardiac arrest but cardiac arrest may lead to shock as well. Sincerely Nomen Nescio 18:55, 30 March 2006 (UTC)

I'm sorry, but you're simply wrong - I don't know how else I can put it. Yes they share some of the same pathological end-points, but they are not the same thing. Can somebody back me up here?!--John24601 20:06, 30 March 2006 (UTC)

I'm a layperson, not a health care professional, but here's my 2 cents. I don't personally care whether cardiac arrest and cardiogenic shock are one page or two, and leave that up to people in the medical project. As a reader, though, I would like someone to clear up the following questions, either on the current cardiogenic shock page or on the combination of the two pages:

• • What are the formal definitions of cardiogenic shock and cardiac arrest?
  • Given that they have different diagnosis codes, under what circumstances should a HCP diagnose one, the other or both.
  • How are they related? Is it possible to experience cardiogenic shock but not cardiac arrest? Is it possible to experience cardiac arrest but not cardiogenic shock?

If someone could expand the article(s) to answer those questions for a lay reader like me, I think it would clarify the article(s) somewhat, and maybe resolve the debate here. TheronJ 21:16, 30 March 2006 (UTC)

Definition:

• Cardiac arrest: Abrupt cessation of cardiac pump function which may be reversible by a prompt intervention but will lead to death in its absence. From Harrison's.
• Cardiogenic shock: the underlying defect is primary pump failure. The causes ... include: (a) myocardial infarction .... (b) .... cardiomyopathy (c) ventricular outflow obstruction [AoS, aortic dissection] (d) ventricular filling anomalies (atrial myxoma, mitral stenosis) (e) acute valvular failure ...(f) cardiac dysrhythmias (g) ventriculoseptal defects. From Irwin and Rippe.

Diagnosis:

• In the acute setting it is not always possible to differentiate between the two. As in most cases, diagnosis is seldom black and white.

Related:

• When in shock due to hypoperfusion of the coronary arteries cardiac arrest may develop, most commonly because of a heart attack.
• Shock is possible without arrest.

Nomen Nescio 18:14, 31 March 2006 (UTC)

I have only one clarification to make to that - it is eminently possible to distinguish between the two - most easily by noting that somebody in cardiogenic shock has a pulse (and heart sounds on auscultation), and somebody in cardiac arrest does not.--John24601 18:57, 31 March 2006 (UTC)

Too BOLD

Realize I was a bit too enthousiastic, therefore I will revert awaiting this discussion. Ans added tag because it needs at least a rewrite. Nomen Nescio 18:14, 31 March 2006 (UTC)

To explain my edits there are several problems:

• Hypoxia - A lack of oxygen to the brain and other vital organs. This is treated by providing the patient with oxygen, either through a bag-valve-mask device, or by inserting an endotracheal tube (intubation)

This is myocardial infarction

• Hypovolemia - A lack of circulating body fluids, principally blood. This is usually (though not exclusively) caused by some form of bleeding. Peri-arrest treatment includes giving IV fluids and blood transfusions, and controlling the source of any bleeding - direct pressure for external bleeding, or emergency surgery (usually an immediate emergency thoracotomy on the ward, to clamp off the descending aorta and achieve haemostasis, the bleed is then repaired properly once the patient has regained circulation) for internal bleeding.

This of course is shock

• Hypo/Hyper-metabolic disorders - An abnormally high or low level of electrolytes such as potassium and calcium circulating the body. An arterial blood gas and blood electrolyte test are performed to find the problem, then IV crystalloids are given to correct it.

This refers to arrhytmia (asystole, VT, et cetera) and potassium, magnesium or calcium disturnances may warrant more than IV crystalloids.

• Hypothermia - A low core body temperature, defined clinically as a temperature of less than 35 degrees celsius. The patient is re-warmed either by using a cardiac bypass or by irrigation of the body cavities (such as thorax, peritoneum, bladder) with warm fluids; or warmed IV fluids. CPR only is given until the core body temperature reached 30 degrees celsius, as defibrillation is ineffective at lower temperatures. Patients have been known to be successfully resuscitated after periods of hours in hypothermia and cardiac arrest, and this has given rise to the often-quoted medical truism, "You're not dead until you're warm and dead."

I have been told that no sensible thing can be said before the patient has normal temperature. But indeed the heart has stopped.

• Tension pneumothorax - A rush of air into one of the pleural cavities which is not able to escape compresses the lungs and causes the trachea to deviate away from the mid-line, often putting pressure on the heart so it is not able to beat effectively. This is relieved in an emergency by inserting a needle into the 2nd intercostal space at the mid-clavicular line, releasing the air and the pressure on the thoracic organs.

This is obstructive shock

• Tamponade (Cardiac) - Blood or other fluids building up in the pericardium can put pressure on the heart so that it is not able to beat. This is treated in an emergency by inserting a needle into the pericardium to drain the fluid (pericardiocentesis), or if the fluid is too thick then an emergency thoracotomy is performed to cut the pericardium and release the fluid.

This is obstructive shock.

• Toxins - Toxic substances which have been ingested or injected into the body can lead to cardiac arrest. This can be evidenced by items found on or around the patient, checking the medical records to make sure no interacting drugs were prescribed, or sending blood and urine samples to the toxicology lab for report. Treatment is mainly supportive, unless there is an antidote which can be administered.

This refers to arrhytmia (asystole, VT, et cetera) and certain drugs require aggressive treatment.

• Thrombosis - Blood clots in the heart (myocardial infarction) or lungs (pulmonary embolism) are both well known causes of cardiac arrest. Treatment includes thrombolysis, and possibly surgical interventions such as angioplasty] or surgical embolectomy.

This is obstructive shock, or myocardial infarction.

IMHO, listing types of shock and arrhythmias as different causes is inaccurate. Beyond that anemia is a cause of infarction I missed in the list. Nomen Nescio 19:10, 31 March 2006 (UTC)

It may be innacurate in your opinion, but it is an integral feature of the UK Resuscitation Council's guidelines for Advanced Life Suppport. They are the people who set the standards for resuscitation throughout the UK, based closely on evidence and recommendations from the European Resuscitation Council and the International Liason Committee on Resuscitation; and therefore it is astonishing, considering that you claim to be a doctor in internal medicine, that not only can you not distinguish between cardiac arrest and cardiogenic shock, but that you have not heard of the 4Hs and 4Ts. Thank goodness that you're not likely to be treating me any time soon! For your information, the guidelines can be found at [1], and if you look on page 48 you will see the section pertaining to reversible causes of arrest, which is almost exactly what is written in the article. --John24601 09:35, 1 April 2006 (UTC)

Edited to add - just incase you think it's still just us crazy brits who do it this way, take a look at the European Resuscitation Council standards (which, as you are in the Netherlands, I assume you work by!), which also mention it - [2] --John24601 09:47, 1 April 2006 (UTC)

I thought I reverted the page in light of your concerns, to react this way is at least rather harsh if not uncalled for. Thank you for those links. And unfortunately the FCCS does not use that classification and still have to do the ACLS, my mistake. Regarding your comments: pulse in shock may also be absent, to state that that is the difference is not correct. At least not always. Although I do not disagree with your list, they all boil down to 1 arrhythmia, 2 circulatory arrest diue to obstruction, 3 infarction (following 2?). On top of that I still miss anemia as cause, you must agree this can elicit myocardial infarction and arrest and should be listed. Nomen Nescio 13:57, 1 April 2006 (UTC)

Added references and additional info. Hope you allow me to redeem myself. Nomen Nescio 15:19, 3 April 2006 (UTC)

So you have accepted now that cardiac arrest exists as a seperate condition from cardiogenic shock? Good. Updates/referencing is much appreciated, thankyou. I have taken onboard some of your concerns re/ the style of the article, and am doing some work on this myself - for instance I've expanded and referenced the prognosis section. --John24601 16:22, 3 April 2006 (UTC)

Definitely separate. I agree with John24601 that these are two clearly distinct (although related) conditions that should not be combined. The Cardiac arrest page looks good to me (and the U.S. teaching is similar to U.K.). The Cardiogenic shock page is a tad muddled...I wonder if in fact it should just be merged into Shock, since it is useful to compare it to the other forms of shock. -- JVinocur 22:19, 11 April 2006 (UTC)

Peri-arrest arrythmias

MI does not show itself on the ECG of someone who is actually in arrest. It may reveal itself after the arrest, or be present before, but during arrest only VF/VT/PEA/asystole can be seen. Someone who has had an arrest secondary to MI usually develops a tachyarrythmia then goes into VT, then VF, then asystole. Resuscitation Council (UK) guidance on peri-arrest arrythmias --John24601 19:17, 3 April 2006 (UTC)

• Wouldn't you think that if a 2nd infarction causes a total occlusion of the LCA there still is rhythm but no output? In other words, why can't the PEA be having signs of ischemia? Nomen Nescio

Hmmmm, you make a good point. I've been treating Cardiac arrest for over 15 years, and teaching about it for the last 8, and have never, ever come across a situation like you describe; but I guess it could be possible. Do you have a reference for it anywhere? Still though, if we listed everything which PEA might reveal.... maybe that (if you do have a reference for it) has its place on the PEA or MI pages, but not on here...--John24601 19:43, 3 April 2006 (UTC)

Why?

Why are these more recent studies deleted and your much older studies from BMJ (certainly not superior to the NEJM) are not?

The out of hospital cardiac arrest (OHCA) has a worse suvival rate (2-8% at discharge and 8-22% on admission), than an in-hospital cardiac arrest (15% at discharge). The principal determining factor is the initially documented rhythm. Patients with VF/VT have 10-15 times more chance of surviving than those suffering from asystole or PEA (as they are sensitive to defibrillation, whereas asystole and PEA are not). Since mortality in case of OHCA is high programs were developed to improve survival rate. A study by Bunch et al showed that although mortality in case of ventricular fibrillation is high, rapid intervention with a defribrillator increases survival rate to that of patients that did not have a cardiac arrest.

Furthermore, it now says that figures are not known. That is not what this text says. IMHO there is no reason to leave this out while it is better sourced and provides figures to the survival rate. Nomen Nescio 13:15, 11 April 2006 (UTC)

In the absence of reasons for deleting this I will restore the clearly well-sourced part on survival rate. Nomen Nescio 16:39, 12 April 2006 (UTC)

True survival rate is not really known, as it depends on an almost infinite number of factors (the patient, their age, their location, underlying cause, co-morbidities, response time, local protocols for treatment, skills of medical staff blah blah...). There are hundreds of studies about, and whilst they all broadly agree qualititavely(ie/ in-hospital is better than out-of-hospital, younger is better than older etc etc etc), none of them have anything like the same quantitative results. For that reason, your studies were probably just as mine, I agree - was actually planning to incorporate them more into the flow of the text (the studies I cited were arranged into in-hospital and out-of-hospital, which is the biggest determinant of survival; whereas yours were just plonked at the beginning) rather than totally delete them, sorry about that - I got a little sidetracked, will get back to it sometime over the next couple of days. --John24601 19:04, 13 April 2006 (UTC)

Recent reversion.

I've just reverted a recent series of edits, as they generally added nothing and in some cases were misinformed to say the least. A few points:

• There is no contraction during diastole, so you can't say that the heart is not contracting properly in this phase
• "The single most treatable cause to prevent cardiac arrests is the early diagnosis and management of acute coronary syndromes (ACS) (also commonly called coronary heart disease) which includes all types of heart attacks and angina. By having ACS signs and symptoms recognised and treated early most cardiac arrests could be prevented." I don't necessarily disagree with the thrust of what is being said here, but it needs to have better grammar and referencing. Furthermore, ACS includes myocardial infarction and unstable angina, but not stable angina.
• "Other less common causes, most often associated with one particular classification of cardiac arrest called pulseless electrical activity (PEA), are known as the 5 H's and the 5 T's." There are 4Hs and 4Ts in all published literature, not 5. These describe ALL the causes of cardiac arrest (ACS/CHD comes under Thrombosis), and they can just about all lead to any rhythm (not just PEA)
• Lay rescuers are taught to commence CPR in the presence of abnormal breathing under the 2005 ILCOR guidelines, movement of skeletal muscle (or any other signs for that matter) doesn't come into it.
• "(a study end point of no value is the return of a pulse and admission alive to the hospial, the only good end point is the patient surviving to leave the hospital functioning and intact- "survivability to discharge")" Not sure that adds anything useful. Especially as that is not an end point of the study. It is for the readers to make up their own mind which figures they give value to. Other little comments throughout the article also add nothing.--John24601 09:35, 1 November 2006 (UTC)

Oxford textbook of medicine as a reference

The wording of the following section is confusing and the reference is difficult to verify:

The out-of-hospital cardiac arrest (OHCA) has a worse survival rate (2-8% at discharge and 8-22% on admission), than an in-hospital cardiac arrest (15% at discharge). The principal determining factor is the initially documented rhythm. Patients with VF/VT have 10-15 times more chance of surviving than those suffering from Pulseless electrical activity or Asystole (as they are sensitive to defibrillation, whereas asystole and PEA are not).

The exact numbers 2-8%, 8-22% and 15% imply statistics generated by one or more academic publications. The Oxford Textbook of Medicine is a good summary of the literature, but is difficult to verify; the book is expensive and likely found only by going to a large library with the book in it's collection. It would be far more useful to directly reference the article the results are derived from. Direct journal references are easy to verify by users with online journal access; users without online journal access can visit a library to access the journal article. Dlodge 18:18, 17 December 2006 (UTC)

Hs and Ts

Per ECC 2005, there are 6 Hs and 5 Ts. [3]. I reverted it back to 6 Hs and 5 Ts, included a citation, and expanded the explanation of the 6 Hs and 5 Ts. If you want to discuss it, please do so here on the talk page. It's proper Wiki etiquette. See: help:reverting. MoodyGroove 22:42, 11 January 2007 (UTC)MoodyGroove

Not sure who exactly wrote those, but it's certainly a deviation from the consensus reached by ILCOR, which as I'm sure you know is the international standard.

If you're interested in ILCOR, you should recognize the American Heart Association, since they are a member of ILCOR. Your claim that 6 Hs and 5 Ts is a deviation from the consensus reached by ILCOR is spurious. ILCOR does not create resuscitation guidelines. The function of the 2005 CoSTR Conference was to evaluate and interpret the peer reviewed evidence that formed the basis for each resuscitation council member (e.g., American Heart Association, European Resuscitation Council) to create resuscitation guidelines, and that's exactly what happened. The 2005 AHA ECC Resuscitation Guidelines are 100% ILCOR compliant. In fact, the 2005 CoSTR Conference was held in Dallax, TX (world headquarters for the AHA). MoodyGroove 16:37, 16 January 2007 (UTC)MoodyGroove

As we're an international, and not regional, encyclopaedia, I think it's reasonable to follow ILCOR's guidance rather than choose a regional variation and highlight that as the standard.

Wikipedia is an international encyclopedia by virtue of being a multilingual encyclopedia. This is the English Wikipedia. Of the estimated 400,000,000 people on Earth who speak English as their primary language, more of them live in the United States than the rest of the World combined. That hardly constitutes a radical fringe group. Regardless, science is universal. There is no cultural bias here. Are you aware of any treatment modalities recommended by the AHA that are not based on the consensus reached by ILCOR? We're arguing about the best way to remember potentially reversible causes of asystole and PEA. If you don't think of it, you can't treat it. MoodyGroove 16:37, 16 January 2007 (UTC)MoodyGroove

All of the things in the 6H5T are just expansions of what is in 4H4T (e.g. hypoglycaemia & hydrogen both fall into the collective heading "hypo/hyper-kalaemia and other metabolites") --John24601 08:28, 12 January 2007 (UTC)

This is your best argument. Let's concentrate on which of the two methods of organizing the information is best, and leave appeals to authority out of it, since both can be backed up by peer reviewed journals. What's the point of having Hs and Ts? It's to jog your memory at 0300 when you're tired and placed in a high stress situation. The more reversible causes you can turn into Hs and Ts, the greater the chance you will think of it during the actual resuscitation. It's the functionality that's important here, moreso than the logic. We're talking about a last ditch effort to save a patient with a very poor prognosis. MoodyGroove 16:37, 16 January 2007 (UTC)MoodyGroove

I noticed that the ACLS Reference Textbook - Principles and Practices (and Experienced Provider Manual) separates Thrombosis into Myocardial infarction and Pulmonary embolism and specifically calls them the '6 Hs and 6 Ts' so I changed the page to reflect that. I think that's easier than remembering '6 Hs and 5 Ts'. MoodyGroove 16:00, 20 January 2007 (UTC)MoodyGroove

This page still needs a lot of work, but I made some significant changes today. The most common cause of PEA is hypovolemia, but I must take issue with the statement that blood loss is the most common cause. In my experience, things like distributive shock or diarrhea are just as common as the GI bleed. I did not change it because I don't have a citation, but I will review the topic in more detail when I get home (I'm on duty right now). MoodyGroove 00:36, 12 January 2007 (UTC)MoodyGroove

I restored content to the 'treatable causes' section that was relevant and factual. The most important treatable cause of cardiopulmonary arrest is VF, and the chain of survival is of paramount importance. That's not controversial. As for the Hs and Ts, two points. First, it's mainly for asystole and PEA. Second, I had hoped by eliminating the numbers we could avoid a content dispute. There is no international consensus that it's 5 Hs and 5 Ts, so removing three high quality references for the sake of changing it back is quite arbitrary. That's not the way to solve the issue. MoodyGroove 17:27, 30 May 2007 (UTC)MoodyGroove

Sorry, I should have explained what I'm doing - at the moment there are big overlaps between sections, and the article is rather muddled. The information on the chain of survival, as you quite rightly say, belongs in the article, but not in the causes section which is where I took it out of. VF is an important type of arrest, but not a cause of arrest, and so it needs more mention in the diagnosis and treatment sections, and so on. I'm planning a series of large edits to the article over the next couple of days to make sure all these things remain included, but in the proper place.--John24601 17:43, 30 May 2007 (UTC)

Sounds reasonable to me. MoodyGroove 17:50, 30 May 2007 (UTC)MoodyGroove

Removed image

I removed an image of an ambulance that had the caption 'People experiencing cardiac arrest are often transported to a hospital via ambulance'. It seemed trivial and barely relevant to the article, more just a case of "we've got this image, lets use it!". --Darksun 15:05, 25 May 2007 (UTC)

Disagree

This edit is entirely incorrect. Clinical death is not synonymous with cardiac arrest. To be declared clinnically dead we use another organ: the brain. Please consider undoing this edit.Nomen Nescio^{Gnothi seauton} 15:45, 30 May 2007 (UTC)

Clinical death refers to a cessation of the heartbeat, and is the traditional criterion for diagnosing death. However, largely due to the advent of effective resuscitation making it potentially reversible, you are quite right we look at irreversible cessation of brain function (as evidenced by brain death, or prolonged cardiac arrest) as true death, rather than the old view of clinical death. --John24601 15:50, 30 May 2007 (UTC)

I think we could look at rewording it. Certainly clinical death is usually diagnosed by ECG (asystole for over 2 minutes) where i am, so death is fundamentally linked to cardiac arrest, but i agree that it's potentially misleading. Maybe something along the lines of "Uncorrected cardiac arrest will lead to certain clinical death"? Owain.davies 18:06, 30 May 2007 (UTC)

I think we're probably confusing terms. Clinical death (at least in my part of the world) is used to refer to those patients who are "traditionally" dead i.e. in cardiac arrest. Left as it is, this is of course actual death, but the initial phase is potentially treatable. All people who are dying go through this phase before they become truly, irreversibly dead. However, it does appear to be causing some confusion - the basic point I'm trying to get across in that paragraph is that any medical condition which has the potential to kill somebody is a potential cause of cardiac arrest. Perhaps somebody can word that better --John24601 18:34, 30 May 2007 (UTC)

We should note that the requirements for declaration of clinical death vary from state to state. —Preceding unsigned comment added by 71.186.22.220 (talk) 13:28, 31 August 2009 (UTC)

Epidemiology

I'd quite like to start an epidemiology section (e.g. numbers affected worldwide, prevalence in different areas etc.). I can probably get hold of some UK stats, but do any of you from other parts of the world have a clue where else we can info? Do the WHO keep tabs on this kind of thing? --John24601 18:43, 30 May 2007 (UTC)

Cardiopulmonary arrest

I've just discovered we have another article at Cardiopulmonary arrest which contains much of the info on here (albeit in less detail). I've tagged both articles suggesting a merge, please add your comments at Talk:Cardiopulmonary_arrest#Cardiac_arrest_vs._Cardiopulmonary_arrest_-_comments_please. Cheers. --John24601 21:11, 30 May 2007 (UTC)

Rating article

Hello. I am not a doctor and I have no medical training. I rated this article stub because my guess is that describing medical conditions in part by amateurs is probably not in anyone's best interest (at least mine when I wondered about pain I was experiencing). I could easily be in error. Thank you. -Susanlesch 20:37, 9 November 2007 (UTC)

Code?

I've seen the word Code used a lot in medical discussions and I wanted to look it up on my trusy Wikipedia. And surely enough the page [[4]] links to this article. But apart from the word "code team" the term Code is never mentioned on this page. If it is a widely used word for cardiac arrest, then this should probably be mentioned somewhere in this article. I'd rather have someone else add it, since I'm in no way sure, that it's a realy synonym. Rentar (talk) 09:33, 27 December 2007 (UTC)

Technically, it's a short form of "code blue" which is a generic code word used in many hospitals to indicate a resuscitation situation exists in a particular location. It's typically given as part of a triple-page. "Code blue, ICU, bed 7. Code blue, ICU, bed 7. Code blue, ICU, bed 7." This lets the "code team" know they need to respond, since multiple trained rescuers will be needed. At our receiving hospital, a "code blue" doen't necessarily imply a full arrest, although most people perceive it to mean a full arrest. From my perspective, it's a trivial, conventional term, that may or may not reflect a world-wide view, and would not contribute much to the article. Best, MoodyGroove (talk) 16:39, 27 December 2007 (UTC)MoodyGroove

Another problem with the term "code" in an encyclopedia article is that it is used in numerous different contexts. Code team [code blue team], "the patient coded [cardiac arrest]," the patient is a full code or a no code or a partial code [Do No Resuscitate status], or, in prehospital care, the patient was transported code" [transported using lights and sirens, i.e. "Code 3"]. As such, the sentence where a stand alone term "code" is used gives as much, if not more, meaning than the actual term "code."JPINFV (talk) 22:46, 13 March 2008 (UTC)

Frequency rate?

I dont see any information in the article about how frequently / what the rate of this medical condition is. Did I just miss it in the article or is some important information missing that someone could add. Lasalle202 (talk) 23:20, 3 March 2008 (UTC)

I presume you mean frequency of occurence? If so, that's easy - it occurs in 100% of people, mostly around the time of their death! OwainDavies ^(about)_(talk) edited at 09:26, 4 March 2008 (UTC)

Post-arrest syndrome

http://circ.ahajournals.org/cgi/content/full/118/23/2452

Recent thorough review. JFW | T@lk 07:41, 5 April 2009 (UTC)

{{editsemiprotected}} 

"Diagnosed" is misspelled as "diadnosed".

75.179.45.0 (talk) 22:58, 25 June 2009 (UTC)

Don't see it. -- Mufka ^{(u) (t) (c)} 23:41, 25 June 2009 (UTC)

Prevention

The thid paragraph of this section, on 27 June 2009, began with this sentence:

Patients in hospital are far less likely to have a cardiac arrest caused of primary cardiac origin, and hence present in asystole or PEA, and have bleak outcomes.

I excised the sentence. It is fatally deformed. I'm no cardiologist. Perhaps a cardiologist or some other type of medical professional might understand what the sentence's author(s) were trying to write. GrouchyDan (talk) 16:47, 27 June 2009 (UTC)

Changes

The separation into out of hospital and in hospital is a false dichotomy. Hospitals do not have "special" abilities.Doc James (talk · contribs · email) 01:56, 14 December 2009 (UTC)

Content removal

I am very unhappy with the recent content removal, and have reverted it back. Happy to remove difference between in hospital and pre-hospital, but the removal of information around reversible causes (and frankly inexplicable change of section heading, making it accessible to only people who already know the information) seems a bit odd to me.

I'm not saying that there aren't valuable changes in there, but this wholesale removal of content and references makes me uncomfortable. Rewriting rather than removing would seem to be far more constructive. Thoughts?

OwainDavies ^(about)_(talk) edited at 09:09, 14 December 2009 (UTC)

Are you referring to the Hs and Ts? The large section of over linked and unreferenced material that is presented as though these are reversible causes? First of all this detail is not presented in an encyclopedic format. Second I have move it to a subpage rather than deleted it and just summarized it here. And finally some of the Hs and Ts are not reversible such as PE.

You reversal by the way has removed referenced content.Doc James (talk · contribs · email) 17:14, 14 December 2009 (UTC)

References

As this is a rapidly changing field it is important to reference to either the AHA guidelines of 2005 of material published latter. With the 2010 ACLS guidelines coming out in 2010 much of this will need updating in a year or so.Doc James (talk · contribs · email) 22:34, 14 December 2009 (UTC)

Ethical issues

Sure some people have DNR orders, but how is that related to the cardiac arrest issue? Hwttdz (talk) 22:53, 26 July 2010 (UTC)

my question what is cardiac arrest

What is cardiac arrest? cardiac arrest is the cessation of normal circulation of the blood due to failure of the heart to contract effectively. what can we do to help ? learn cpr to help someone who is in need, i learn u can prevent some cardiac arest problems with diet and weight management and excercise and certain tests u can get. But some cardiac problems can't be prevented. — Preceding unsigned comment added by 74.243.53.140 (talk) 01:46, 25 October 2011 (UTC)

Epinephrine

I've just reverted an edit about a recent large observational study of the immediate and one-month outcomes from the use of epinephrine in cardiac arrest patients prior to hospital arrival. The abstract is here. Though it's a large (>400,000 subjects) study it's afflicted by many of the limitations common to observational studies, and, as a primary source, is not recommended for health-related content, per WP:MEDRS. Once the findings have been replicated, or supported by better controlled evidence, and it's all contextualised in a systematic review or similar, we'll have a better understanding of how much, if any, weight to assign to it. --Anthonyhcole (talk) 04:37, 23 March 2012 (UTC)

wearing tight underwear on men is the main cause of cardiac arrest.

Imagine wearing tight ties on necks causes sudden dizziness or even heat stroke on hot summer days, cardiac arrest is a deadly effect of rubber bands on waist and thighs. Observation on sleeping death victims have marks on. — Preceding unsigned comment added by 112.198.64.38 (talk) 05:13, 26 September 2013 (UTC)

Read in panic

I've moved DNR do not resuscitate to 'other' because anyone skimming through or reading in a panic is going to conclude that they should not resuscitate. CPR is rare enough as it is. 61.3.191.64 (talk) 15:26, 28 October 2013 (UTC)Think

I've changed it make it more specific.61.3.191.64 (talk) 15:45, 28 October 2013 (UTC)Feel

This is one of the more common wishes for management. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:01, 28 October 2013 (UTC)

You haven't answered the concern. Also it should be distinguished. One for life sustainable and the other as a choice on how you die. 117.207.232.48 (talk) 19:50, 29 October 2013 (UTC)Die?

Wikipedia does not offer medical advice. Page layout and formatting complies with attempts to improve it as an encyclopedic article, not because of a hypothetical situation where someone would use the section titles alone as advice in an emergency situation. DNR is a form of management in the event of a cardiac arrest and thus it should be a subsection under that. — Reatlas (talk) 02:20, 30 October 2013 (UTC)

I share Reatlas's position. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:14, 30 October 2013 (UTC)

Recent RCT questions benefit of hypothermia

How should we combine this? Have added one sentence.

Nielsen, Niklas (17 November 2013). "Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest". New England Journal of Medicine: 131117131833001. doi:10.1056/NEJMoa1310519. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

The size of this trial is twice as big as the combined number of patients in the previous systematic review. [5]

Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:37, 18 November 2013 (UTC)

In my opinion, the NEJM is the best (most reliable) medical journal. As such, I am fairly relaxed about using its (primary) RCT conclusions in Wikipedia's articles. In this case, it should be single sentence after the Cochrane finding, stating that a major RCT showed a different conclusion. Axl ¤ [Talk] 00:06, 19 November 2013 (UTC)

Agree which is more or less what I have done. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:09, 19 November 2013 (UTC)

Cardiac arrest Vs Heart attack

A heart attack is when blood flow to the heart is blocked, and sudden cardiac arrest is when the heart malfunctions and suddenly stops beating unexpectedly. A heart attack is a “circulation” problem and sudden cardiac arrest is an “electrical” problem

Okay and? Doc James (talk · contribs · email) 01:51, 13 October 2016 (UTC)

You have got to be kidding me - cardiac arrest in men vs women

Since only MEDRS are allowed here and this article is rated B-Class, I thought I would learn something fundamental about cardiac arrest differences between men and women. Here is all I found:

• It affects males more often than females. (ref does not mention any particular study)
• Women are more likely to survive cardiac arrest and leave hospital than men ( referenced by a 2015 study)
• The lifetime risk is three times greater in men (12.3%) than women (4.2%) (referenced by a dead link)

Surely there is more known about this? Ottawahitech (talk) 08:50, 30 December 2016 (UTC)please ping me

This seems like a mistake: "The initial heart rhythm is most often ventricular fibrillation"

This seems like a mistake: "The initial heart rhythm is most often ventricular fibrillation.[4]"

According to the VF article, it's only 10% of the time.

According to the Asystole article, asystole is 28% of the time, which is obviously more than VF's 10%.

According to the page on PEA https://en.wikipedia.org/wiki/Pulseless_electrical_activity , PEA "is found initially in about 55% of people in cardiac arrest" which also obviously more than VF's 10%. So I don't see how the cardiac arrest page can be right unless both of the others are wrong.

Also, the footnote for the line I think is a mistake links to this page: https://www.nhlbi.nih.gov/health/health-topics/topics/scda/causes but I can't find the place where it got the information about VF being the most common initial rhythm.

207.172.175.134 (talk) 08:44, 16 January 2017 (UTC)Ross

VF most often preceded asystole as well. The very first sentence of the source you linked corroborates the statement. Carl Fredrik 💌 📧 09:12, 16 January 2017 (UTC)

You're right, I overlooked that sentence. However, don't the other pages still seem inconsistent or at least confusing when compared. It certainly isn't clear to me and I've spent time on all the pages. 207.172.175.134 (talk) 10:23, 22 January 2017 (UTC) RC

Which text on which pages seem unclear? Doc James (talk · contribs · email) 17:24, 22 January 2017 (UTC)

Cardiac Arrest vs Heart failure

They aren't the same thing, right? This article seems to say they are. I thought one (CA) is when the heart stops beating completely, and heart failure is when it can't pump enough blood to meet the body's needs The snare (talk) 02:03, 23 March 2017 (UTC)

Not the same. Were do you think it says they are? Doc James (talk · contribs · email) 10:13, 23 March 2017 (UTC)

Work Plan

-Sections I will prioritize? Causes, management, epidemiology. In particular, during initial article review I found the Causes section to have contradictory statements that need further clarification and references to be updated, I plan to expand the risk factors portion of causes as well. Management section I will look for updating statistics of CPR outcomes, expand on defibrillator use by public adding outcome data. -Resources I intend to look up, and when? I intend to use Clinical Key, UptoDate for background info and use pubmed, national guideline clearinghouse for the epidemiology and expert consensus statements. I plan to find my sources over this next week. -How will I decided on what things to specifically include, exclude? As I get more familiar with the current literature I will have a better idea on what is necessary to include in this wikipedia page to maximize readability. In terms of what to exclude, some things I have already seen are contradictory to other parts of the article and some have very little applicability to the topic i.e. including brief reference to 'near death experiences'. -Will I also embed additional links to other Wiki pages? There are already quite a lot of internal links to other wikipedia pages, most seem to be for 'jargon' type words. I will review the internal links to see if they are correct but do not imagine needing very many new ones. -I will ensure that I avoid 'doctor speak' and the use of medical jargon by being cognizant of the intended audience and run my writing through some of the tools for alternative word usage. JSShin (talk) 20:37, 20 November 2017 (UTC)

I look forward to seeing some of the edits you mentioned in the progress meeting. AngeladMD (talk) 14:35, 29 November 2017 (UTC)

Updated work plan. After spending considerable time reviewing the primary sources I believe the section that I can improve the most, in the allotted time is the 'Causes' section. My emphasis will be on re-writing the section in a cohesive, readable way for the general public and will try and break down the major categories of causes in a logical fashion. I will also make corrections to the few grammatical errors I have found in the other sections, and exclude a number of minor points made in other sections for the sake of clarity. JSShin (talk) 22:21, 1 December 2017 (UTC)

Notable under society and culture maybe?

"In some medical facilities, the resuscitation team may purposely respond slowly to a person in cardiac arrest, a practice known as "slow code", or may fake the response altogether for the sake of the person's family, a practice known as "show code". This is generally done for people for whom performing CPR will have no medical benefit. Such practices are ethically controversial, and are banned in some jurisdictions."

Doc James (talk · contribs · email) 22:34, 1 December 2017 (UTC)

-agree this is a more appropriate location for mentioning "show code. will give further thought to section title JSShin (talk) 22:42, 1 December 2017 (UTC)

Sounds good. Doc James (talk · contribs · email) 18:42, 2 December 2017 (UTC)

Peer Review

Hi Josh! Great work editing this article, especially since its probably one of the more time-intensive topics to look into.

-You did a great job avoiding jargon in the 'causes' section and using links to additional Wikipedia articles for further information on the arrhythmias discussed.

-It might be helpful to include a bulleted list of the causes of cardiac arrest before going on to explain each one

-Under CAD, the article mentions LVH as a leading cause of SCD. While this is probably true, you could move it down to the next section which discusses structural heart disease not related to CAD.

-Since you included a link to the article on Long QT syndrome, you could consider removing the description of long QT included under arrhythmias to streamline the article some.

-There are a few instances where the article seems to use primary articles (under the ICD section). May want to find higher level evidence for this information. Instead of referencing trials (ie MADIT-II trial) that can't be searched in Wikipedia, you could try summarizing some of the criteria that would qualify a patient for ICDs.

-The section under Targeted Temp Management also seems to cite a few primary articles. This area could use some summarizing instead of presenting so many statistics. Same with the "other" section

-The Epidemiology section seems out of place. You might want to move it earlier in the article.

-This article is pretty comprehensive. Overall, great job! If you wanted to pick one section to focus on, I would probably choose to clean up the 'management' section.

Lindseyshehee (talk) 16:14, 10 December 2017 (UTC)

Hello everyone, WikiProject Medicine student here to help contribute!

I am currently a 4th year medical student taking a WikiProject Medicine course. This course places an emphasis on helping improve Wikipedia pages that are related to medicine in order to contribute valuable medical knowledge to the general population. My intention is to improve this article over the next four weeks initially during this course, and then continue to improve upon it moving forward as well. I am honored to have this opportunity because I believe that I can better educate the population through this project, and cardiac arrest is an important topic that many individuals would like to know about. Since this page hasn’t been revised in more than a year, I believe this is a great page to start on. It is also currently graded as a “C” article because of lack of detail and references on the project’s quality scale, and given “High-importance,” and as such I’m excited to get started and help revise the page. One of my fellow colleagues who also took this course worked on the page Chest Pain, and this is what I will be using a model in terms of revising and editing to make improvements.

Section by section my improvements will focus on:

Introduction: Expand the introduction with more sources and make it more understandable to the general public. There's terms utilized in this introduction constantly that I don't believe the general public would be able to understand, so if these terms are to be kept then they must be clarified and described, because as we've learned during the course this is an example of a quality article. This is particularly important because most individuals will see this first and if they can't understand these terms they may not continue to read.

Signs and Symptoms: I plan on adding more information to these section because most individuals will want to know if what they are experiencing, heard about, etc. is cardiac arrest. I intend on adding more resources as well on the specific signs and symptoms one can have related to cardiac arrest because there aren't many resources for this section. There is a similar area of improvement in this section in that some of the terms need to be simplified so that the general public is able to understand.

Causes: I intend on adding more resources to this section, but most of this seems to be very well detailed already in terms of content so I don't think much needs to be added in terms of that. The mnemonic is a great addition, but that along with the rest of this section also needs to be clarified more. I can understand this as a medical student but I want this to be more accessible to the public as well.

Mechanism: I want to expand on this section as well since there's only around 2 sentences with 2 resources. More details can be provided regarding the heart's electrical system that is in place that could go array leading to ventricular fibrillation, which will help others understand from a basic perspective what can go array and how that can cause the overall big picture of cardiac arrest.

Diagnosis: There's only a few resources cited here as well and I think this section should have specific emphasis placed as well when I am revising. This could be the section a potential patient is focusing on when they're not able to understand the process of determining if they have had cardiac arrest or not.

Prevention: I think this is overall one of the best sections on this page. I can clarify more regarding the details of what is already explained, but I think this section is well written. I will add more resources as well since not all the sentences have resources after them.

Management: This is also a well written section with a lot of detail regarding management and what can be done. However, there are full sub-sections under this Management section that have no resources at all, and I can add those.

Prognosis: I would like to see if I can find more updated forms of data regarding prognosis since the only detail providing regarding this from a review is from 1997. There are other studies mentioned but those are also not recent so it would be helpful to have more updated data regarding the statistics of someone with cardiac arrest.

Epidemiology: There isn't much in this section at all, and I would like to provide sourced epidemiological data on gender differences, regional differences, admission rates, morbidity/mortality rates, and other epidemiological data that is present already.

For this workplan, I wanted to explicitly discuss that not all facts are referenced with an appropriate reference and I would like to fix that as I discussed above. Everything included in the article thus far is relevant and nothing distracting is present which is great. The article is neutral and no bias, and the information is coming for neutral sources. There aren't any viewpoints that are overrepresented or underrepresented. There are some links that don't work for the citations throughout the article and I will fix that as well. There is some information out of date as I discussed in the prognosis section and I will attempt to find more up to date articles. I will prioritize editing the introduction and the diagnosis section since those are the sections usually given most emphasis when looked up by the general public. I will ensure no "doctor-speak" by attempting to maintain everything at a middle school reading level so that this article will be informative to as many people as possible.

Thank you all for your time reading through this, and if any of you are looking at this page I would love your help. If there is any particular changes you think I should be focusing on please let me know. We can make a tremendous difference together because this is a highly viewed page and is quite important to the medical field. If anyone has any suggestions throughout this process please feel free to let me know, I would love to hear them. Thanks everyone! — Preceding unsigned comment added by Marvisq358 (talk • contribs) 18:19, 23 October 2019 (UTC)

Peer Review (WikiProject Medicine - Fall 2019)

I enjoyed reading your article very much! Here are some thoughts and improvements for you.

OVERALL
Flow: I love the flow of the article! Nice and simple for the public to read.
Structure: Easy-to-read headings that made sense. One improvement can be that when you are listing multiple things in a sentence, you could potentially just add bullet points.
Readability: Avoided medical jargon! Success.

SECTIONS
Introduction - Good synopsis, can be improved by potentially giving another example or two of inherited disorders.
Signs & Symptoms - Great edits. First sentence can possibly be improved by using active voice... ie. "In approx 50% of people, there are no warning signs preceding cardiac arrest."
Causes - Great job - I like how it's broken down into CAD, structural, inherited syndromes, and non-cardiac causes.
Mechanism - Electrical mechanisms can be expanded on in this section.
Diagnosis - I like the addition of the history section... a possible improvement can be a robust review of what you can ask the patient. At the same time, this might be a bit much. Either way, I like the emphasis on history-taking!
Management - Great addition of CPR steps... a good review for anyone.
Epidemiology - Great synopsis of major risk factors. Can race be expanded on in this section?
Medications - Could probably say "The use of dose-dependent calcium, based on weight, has been associated.... To calculate medication dose quickly, the use of Broselow tape is recommended."

Overall, a job well done! Thank you for letting me be a part of the peer review process.

Sincerely,
ILikeToIntubate — Preceding unsigned comment added by 108.200.218.71 (talk) 06:10, 11 November 2019 (UTC)

Acidosis appearing during SCA

Acidosis appearing during SCA and its Dx, Tx is missing. --12:32, 3 April 2020 (UTC) — Preceding unsigned comment added by 2003:C3:EF1A:E202:70AC:64B:52F9:6431 (talk)

Slow code

This article describes the above practice. This is presumably a recognition by medical professionals that resuscitation will not work, but is actually not a good substitute for the much more ethical practice of instituting Do Not Attempt CPR decisions. The article makes no mention of these. I made an edit but it got deleted as I cited no sources. If I get a chance I will do it properly, with references. The fact is that CPR can be harmful (e.g. patient denied a peaceful and dignified death) and in cases where it would certainly be futile, it should be avoided. Gavaan (talk) 03:03, 6 July 2020 (UTC)

This article is inherently wrong

This is an article about heart disease and heart failure. It is NOT an article about cardiac arrest.

Cardiac arrest occurs when the heart does not receive the electricity it needs to function.

You can have a perfectly healthy heart and still drop dead of cardiac arrest because the medulla oblongata stops sending electricity to the heart, so that it stops beating.

2601:645:C300:5120:85A9:9144:B17D:E232 (talk) 07:50, 24 May 2021 (UTC)

" Invariably fatal"?

Yes, it is (almost?) universally fatal if not treated immediately, but this particular wording makes it seem absolute. Decapitation is something which qualifies for that qualification, this one... really doesn't. --181.115.61.74 (talk) 04:35, 16 October 2021 (UTC)

UCF WikiMedicine Project: Plan to Edit Fall 2021

Hello we are members of the UCF Medical School team volunteering to edit pages within the wikimedicine catalog. We would like to make some updates to the article based on the recommendations above by JacknowledgeMD and further holistic research to build it's impact. We will soon continue our training in residency positions in Pathology and Emergency Medicine. We would like to specifically make the following edits:

Introduction: (Kjlockart) Expand the brief introduction the outcomes and expectations of cardiopulmonary resuscitation currently listed to illustrate the comparison of prognostic expectations of the general public as a result of fictional media and true clinical data. Include specific risks/outcomes of cardiopulmonary resuscitation to build on the disabilities previously introduced. (vsnguyen.em): Clarify factual statements to increase the ease of readability to the audience. Restructure the organization of paragraph 2 to create better flow of most common to lesser common causes of cardiac arrest. Provide more context behind an ICD placement to increase the chance of survival. Include survival statistics in in-hospital cardiac arrest.

Signs and Symptoms: (vsnguyen.em) Provide sources for claims in the first paragraph and bullet-point symptoms

Causes: (Kjlockart) Explain the pathophysiology of various causes of cardiac arrest in more detail (Coronary Artery Disease, Structural Heart Disease, Inherited Arrythmia Syndromes, etc.) I would like to include the changes in cardiac tissue that result from these causes and use images to illustrate these ideas. (vsnguyen.em) Grammar throughout all paragraphs, altered to enhance the audience's understanding. Provide mechanism for why arrhythmias can cause cardiac arrest under "inherited arrhythmia syndromes." Provide mechanisms for non cardiac causes of cardiac arrest.

Mechanisms: (Kjlockart) Further describe the implications of ventricular fibrillation and how it leads to cardiac arrest. Also describe additional mechanisms for cardiac arrest beyond V Fib. This section seems relatively brief considering many will presumably come here looking for a detailed description of the exact cause of arrest. (vsnguyen.em): propose that Causes and Mechanisms get placed under 1 Subtitle to address the cause and then explain the mechanism behind it that leads to cardiac arrest. Because there are multiple causes to cardiac arrest, explaining the mechanism in the same section would be clearer to the audience.

Epidemiology: (Kjlockart) Attain up to date sources on the prevalence in various ethnicities and sociologic factors

Diet: (vsnguyen.em) Develop the section more with links and recommendations from the AHA.

Medications: (vsnguyen.em) Include the purpose for each medication use in the setting of cardiac arrest (epinephrine and vasopressin). Include dosage recommendations in the current guidelines.

Looking forward to making a contribution!

Kjlockart (talk) 16:54, 25 October 2021 (UTC) Vsnguyen.em (talk) 23:03, 27 October 2021 (UTC)

UCF WikiMedicine Project: Peer Review Comments

- Lead section is well developed and gives a great snapshot of the rest of the article - The structure of the article has a logical flow - The topics discussed receive balanced coverage and present the information in a neutral context. - In my opinion, I think it might help the flow to have the Epidemiology section closer towards the top of the article - In the "Causes and Mechanisms" you say "Sudden cardiac arrest can result from cardiac and non-cardiac causes including the following:" In my opinion, it would maybe flow better if you have a header saying "Cardiac Causes" and then keep the subdivision of those as already written. Then another header "Non-Cardiac Causes". I also think the non-cardiac causes section could be expounded on a bit. For each of the causes listed in the pneumonic maybe have like a sentence or two on how these cause cardiac arrest. For the CPR section, I would maybe include a mention about how many times CPR can lead to broken ribs. In this section, you also mention that CPR by bystanders involves only chest compressions. It would be nice to include a sentence on why it is recommended that bystanders only perform chest compressions and not mouth-to-mouth (risk of catching infectious disease etc.) You could also mention that bystanders can carry the keychain CPR one-way breath valve cover. ChrisHurtado7129 (talk) 00:58, 17 November 2021 (UTC)

Peer Review of Kjlockart and Vsnguyen.em by WikiProject Student

Hello,

Tremendous work on this article about cardiac arrest! Everything in this article is relevant to the article topic, and is mostly understandable to the general Wikipedia audience. Furthermore, the content is neutral, and most facts are supported by an appropriate and reliable source with the exception of reference number 31. In particular, the 'Causes and mechanisms' section provided a clearer explanation of cardiac arrest to the Wikipedia audience.

Below are some suggestions for possible improvements to the article:

Signs and symptoms

• I suggest modifying the sentence, "For those who do experience symptoms, they will be non-specific," to "For individuals who do experience symptoms, the symptoms are usually non-specific."
• Also, consider citing the above sentence's claim with a secondary source.

Causes and mechanisms

• UpToDate is used as a source of reference. However, I would suggest changing it to another secondary source since Wikipedia does not recommend UpToDate as a reference.
• I also suggest utilizing separate headers for "Cardiac causes", or "Non-cardiac causes". That may make it easier for the general audience to follow.

Diet

• Consider providing a link for "American Heart Association" in the "Diagnosis" section since that is where it appears first.

Thank you very much for your work! Joshua Cho28 (talk) 04:05, 17 November 2021 (UTC)

Queen's Medical Students: Proposed Changes

Hello, we are a group of medical students editing this page as part of our class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:

Signs & Symptoms

We propose to modify the second paragraph to include the following information: "When cardiac arrest is suspected due to signs of unconsciousness or abnormal breathing, a bystander should attempt to feel a pulse for 10 seconds; if no pulse is felt, it should be assumed the victim is in cardiac arrest. As a result of loss of blood flow to the brain (cerebral perfusion). 20crw4 (talk) 01:14, 19 November 2021 (UTC)

References

Thanks for sharing this suggestion @20crw4:. The last sentence "As a result of loss of blood flow to the brain (cerebral perfusion)" seems truncuated. What does this refer to? I have re-added your citation using the correct tool. This is more difficult to do on the talk page as the visual editor tool does not work here. Please be sure to add it correctly when you are editing the article live. You can practice as well in your sandbox. Nice work here!JenOttawa (talk) 01:23, 22 November 2021 (UTC)

Causes & Mechanisms

Proposed change # 1: Proposed change includes adding a final sentence under the #Children subheading which will say: Common causes of sudden explained cardiac arrest in children include hypertrophic cardiomyopathy, coronary artery abnormalities, and arrhythmias. 8je11 (talk) 21:01, 16 November 2021 (UTC)

Feedback: This looks good. Great adding your reference properly as well. JenOttawa (talk) 15:48, 28 November 2021 (UTC)

Proposed change # 2: Additionally, we propose adding definitions of V. Tach, V. Fib, and the difference between them to the mechanisms section. This will help clarify the different mechanisms of cardiac arrest in a clear and reader-friendly manner. Clecce (talk • contribs) 03:26, 19 November 2021 (UTC)

Thanks @Clecce:. If you are re-using the same citation, please ensure you know how to "re-use" it versus adding it twice to the reference list.JenOttawa (talk) 15:48, 28 November 2021 (UTC)

Proposed change #3: Final paragraph of section following the sentence "“The mechanism responsible for the majority of sudden cardiac deaths is ventricular fibrillation.” : Ventricular fibrillation is a tachyarrhythmia characterized by turbulent electrical activity in the ventricular myocardium leading to a heart rate too disorganized and rapid to produce any meaningful cardiac output, thus resulting in insufficient perfusion of the brain and essential organs. Some of the electrophysiologic mechanisms underpinning ventricular fibrillations include ectopic automaticity, re-entry, and triggered activity.18jp54 (talk) 18:51, 19 November 2021 (UTC)

Proposed chnage # 4: Following the V-fib paragraph, we propose adding the following information about V-tach: "Ventricular tachycardia (V-tach) is characterized by a wide QRS complex, a heart rate greater than 100 beats per minute, and can be monomorphic (stable beat to beat QRS complex) or polymorphic (changing beat to beat QRS). Polymorphic V-tach is estimated to cause approximately 25% of cardiac arrest cases, however monomorphic V-tach leads to cardiac arrest only if it degenerates into polymorphic V-tach or ventricular fibrillation (V-fib), or if other conditions contribute to insufficient circulation. The fast and irregular heartbeat associated with polymorphic V-tach leads to sudden cardiac death as it causes a lack of adequate blood flow to systemic circulation and heart tissue."

Feedback: Be sure to add the citation immediately after the punctuation, with no spaces. You can also re-use the same citation for your second sentence. I.e.- it will look like this: Following the V-fib paragraph, we propose adding the following information about V-tach: "Ventricular tachycardia (V-tach) is characterized by a wide QRS complex, a heart rate greater than 100 beats per minute, and can be monomorphic (stable beat to beat QRS complex) or polymorphic (changing beat to beat QRS). Polymorphic V-tach is estimated to cause approximately 25% of cardiac arrest cases, however monomorphic V-tach leads to cardiac arrest only if it degenerates into polymorphic V-tach or ventricular fibrillation (V-fib), or if other conditions contribute to insufficient circulation. The fast and irregular heartbeat associated with polymorphic V-tach leads to sudden cardiac death as it causes a lack of adequate blood flow to systemic circulation and heart tissue. JenOttawa (talk) 15:48, 28 November 2021 (UTC)

Overall Feedback: @8je11 and Clecce: For the first change, can any of these terms be wikilinked: hypertrophic cardiomyopathy, coronary artery abnormalities, and arrhythmias? We only usually link a term the first time it appears in the article. These edits look great! JenOttawa (talk) 01:34, 22 November 2021 (UTC)

References

Diagnosis

Final sentence from the first paragraph in the 'Diagnosis' section of the original Wikipedia article (cardiac arrest):

In many cases, lack of a carotid pulse is the gold standard for diagnosing cardiac arrest, as lack of a pulse in the periphery (radial/pedal) may result from other conditions (e.g. shock), or simply an error on the part of the rescuer. Nonetheless, studies have shown that rescuers often make a mistake when checking the carotid pulse in an emergency, whether they are healthcare professionals or lay persons.

Feedback- this edit looks good. I tend to not use citation mid-sentence and rather consolidate them at the end of the sentence (or after a comma), but all of us have different writing styles and I do not think that there is a rule against this. Good job re-using the same citation (versus adding them a second time).JenOttawa (talk) 15:51, 28 November 2021 (UTC)

Proposed changes (adding after the original Wikipedia sentence):

Point-of-care ultrasound (POCUS) is a tool that can be used to examine the movement of the heart and its force of contraction at the bedside of a patient experiencing cardiac arrest. POCUS can accurately diagnose cardiac arrest in hospital settings, overcoming some of the shortcomings of diagnosis through checking the central pulse (carotid arteries or subclavian arteries), as well as detecting movement and contractions of the heart.

Feedback: This looks great. JenOttawa (talk) 15:51, 28 November 2021 (UTC)

Using POCUS, clinicians can have limited, two-dimensional views of different parts of the heart during arrest. These images can help clinicians determine whether electrical activity within the heart is pulseless or pseudo-pulseless, as well as help them diagnose the potentially reversible causes of an arrest. Published guidelines from the American Society of Echocardiography, American College of Emergency Physicians, European Resuscitation Council, and the American Heart Association, as well as the 2018 preoperative Advanced Cardiac Life Support guidelines, have recognized the potential benefits of using POCUS in diagnosing and managing cardiac arrest. Dandilliott (talk) 23:58, 17 November 2021 (UTC)

Feedback: This edit looks good. Would it be worth trying to define "pseudo" in your sentence? JenOttawa (talk) 15:51, 28 November 2021 (UTC)

References

Management

Proposed change for the first paragraph of the medications section:

• Based on 2019 guidelines, 1mg of epinephrine may be administered to patients every 3-5 minutes, but high dose epinephrine is not recommended for routine use in cardiac arrest. If the patient has a non-shockable rhythm, the epinephrine should be administered as soon as possible. For a shockable rhythm, epinephrine should only be administered after initial defibrillation attempts have failed. Rosie0317

Thanks for sharing this. Do you mind also sharing your proposed citation to support this @Rosie0317:JenOttawa (talk) 18:42, 16 November 2021 (UTC)

Please see the following citation to support this proposed change.

Thanks @Rosie0317: This looks great. Be sure to add it using the citation tool when we edit live tomorrow. I know it is different here on the talk page (as the visual editing tool is not available). Please review your actual edit tomorrow carefully to make sure the citation looks good. Example (when I used the citation tool). JenOttawa (talk) 19:02, 28 November 2021 (UTC)

References

Proposed change for the first two sentences of the Targeted Temperature Management section:

• Current international guidelines suggest cooling adults after cardiac arrest using targeted temperature management (TTM), which was previously known as therapeutic hypothermia. Tasricha (talk) 18:53, 18 November 2021 (UTC)Tasricha

Feedback: Thanks for sharing this. Looks good. JenOttawa (talk) 20:56, 28 November 2021 (UTC)

Proposed change for the first sentence of the second paragraph in the Targeted Temperature Management section:

• Effectiveness of TTM after out-of-hospital cardiac arrest is an area of ongoing study.

Feedback. Looks good. Be sure to place your citation immediately after the punctuation like this.JenOttawa (talk) 20:56, 28 November 2021 (UTC)

Proposed change for the second paragraph of the Target Temperature Management section:

• A 2018 systematic review and meta-analysis suggests that TTM in post-arrest care does not improve mortality or neurological outcomes. Moreover, TTM may have adverse neurological effects in people who survive post cardiac arrest. Tasricha (talk) 18:53, 18 November 2021 (UTC)Tasricha

Hi, nice work here @Tasricha:. We do not need to share the information about the source in the sentence. I would suggest changing this edit to read something like this: TTM in post-arrest care has not been found to improve mortality or neurological outcomes. Moreover, TTM may have adverse neurological effects in people who survive post cardiac arrest. (assuming TTM has been defined earlier?) Not that I moved the citation to immediately after the punctuation and also added it (re-used, not added it a second time) after each sentence) JenOttawa (talk) 20:56, 28 November 2021 (UTC)

Proposed addition for second paragraph of Targeted Temperature Management section:

• Another recent meta-analysis suggests pre-hospital TTM after out-of-hospital cardiac arrest may increase risk of adverse outcomes, with rates of re-arrest higher in cases of pre-hospital TTM. These recent studies suggest more research is needed surrounding TTM.

Feedback:@Aditya 6028: This edit looks good. Please ensure TTM is defined earlier in the text and is a fairly common acronym. Please avoid the use of the term "recent" as people on Wikipedia cannot see when this was added. Rather you can use the exact date, if you wish to reference the timing of evidence. In addition, no need to mention that this was from a meta-analysis. I would suggest changing this to read: Pre-hospital TTM after out-of-hospital cardiac arrest has been shown to increase the risk of adverse outcomes. The rates of re-arrest may be higher in people who were treated with pre-hospital TTM, however, more research is needed on the effectiveness and risks of TTM.

Note that I re-used the citation each time rather than adding it each time from scratch and also included a ref after each sentence. This ensures that there is only one version on the ref list. In addition, please check the strength of evidence from the meta-analysis. I added a "may be higher" as, given evidence base is weak, this is likely not a strong or very strong finding. I did not re-read your meta-analyses though so please check and adjust as needed. For re-using the references, you click on the "cite" tool as we practiced in class, however, rather than clicking "auto" to autogenerate your citation, you click "re-use" and select your reference that is already added from the list. Hope this helps! Thanks again! JenOttawa (talk) 21:13, 28 November 2021 (UTC)

References

Prognosis

We have compiled a list of suggestions to update the prognosis section of the cardiac arrest page and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:
Edit#1:
• We propose the inclusion of the following paragraph which updates the out-of-hospital cardiac arrest survival rate and incudes data on factors that have been demonstrated to improve out-of-hospital cardiac survival: “One study estimated that the global rate of patients who were able to recover from out-of-hospital cardiac arrest after receiving CPR was 29.7%. The rate of survival until discharge from the hospital was 8.8%. The same study found that the 1-month survival rate of out-of-hospital cardiac arrest was 10.7% and the 1-year survival rate was 7.7%. Survival until discharge from the hospital was more likely among patients whose cardiac arrest was witnessed by a bystander or emergency medical services, who received bystander CPR and among those living in Europe and North America. Relatively lower survival to hospital discharge rates were observed in Asian countries.

Feedback: Thanks for sharing this here. Please note that a systematic review is not considered a study, or do the results of the systematic review indicate that one study found this? Please verify, I have not read your source. It may not be necessary to share all this information in the first place. For example, adding in: The global rate of patientspeople who were able to recover from out-of-hospital cardiac arrest after receiving CPR has been found to be approimately 30%, and the rate of survival until discharge from the hospital has been estimated at 9%. In addition, The same study found that the 1-month survival rate of out-of-hospital cardiac arrest is approximately 11% was 10.7% and the 1-year survival rate was 7.7%8%. Survival until discharge from the hospital was is more likely among patients people whose cardiac arrest was witnessed by a bystander or emergency medical services, who received bystander CPR and among those living in Europe and North America. Relatively lower survival to hospital discharge rates were observed have been observed in Asian countries. Please note that I added citations after each sentence as well in this edit. This is just an idea, hope that it helps.JenOttawa (talk) 21:51, 28 November 2021 (UTC)

Edit#2:
• We propose the following update to in-hospital cardiac arrest survival: “For those who have an in-hospital cardiac arrest, the survival rate one year from at least the occurrence of cardiac arrest is estimated to be 13.4%. One year survival is estimated to be higher in people with cardiac admission diagnoses (39.3%), when compared to those with non-cardiac admission diagnoses (10.7%).

Feedback: This looks great I tend to round the %s, but this is likely personal preference I am not sure if there is a guideline on this for Wikipedia. I suggest re-using your same source after each sentence. The reason for this is that if another editor comes in after you and adds something, accidentally truncating your work, the reference associated with the first sentence is lost. Please click "re-use" when adding your citation rather than adding it again (so it appears once not twice in your reference list). JenOttawa (talk) 22:15, 28 November 2021 (UTC)

Edit#3:
• We propose the following expansion on the information about neurological outcomes: “Hypoxic ischemic brain injury is the most detrimental outcome for people suffering a cardiac arrest. Poor neurological outcomes following cardiac arrest are much more prevalent in countries that do not use withdrawal of life support (~50%) as compared to those that do (less than 10%). Most improvements in cognition occur during the first three months following cardiac arrest, with some individuals reporting improvement up to one-year post cardiac arrest. 50 – 70% of cardiac arrest survivors report fatigue as a symptom, making fatigue the most prevalent patient-reported symptom."

Looka good. Can you please re-use your citation after each sentence? That way if someone comes on after you and edits the article (and adds in something in the middle of your paragraph) the citation for these statistics is not lost.JenOttawa (talk) 22:15, 28 November 2021 (UTC)

Atakaoka (talk) 16:48, 18 November 2021 (UTC)

References

Prevention

We are proposing the following changes to the Prevention section. We would appreciate feedback from the Wiki community prior to making the changes.

1. Adding before the last sentence of the first paragraph of the ‘Prevention’ section: Exercise is an effective preventative measure for cardiac arrest in the general population but may be risky for those with pre-existing conditions. The risk of a transient catastrophic cardiac event increases in individuals with heart disease during and immediately after exercise. However, both the lifetime and acute risk of cardiac arrest are decreased in individuals with heart disease that perform regular exercise, suggesting the risks of exercise are outweighed by the benefits.

Looks good. I like how you re-used the citaiton in your text. Please note: The first time you add it (or it is used in the article) you need to add it using cite tool that autopopulates the fields. The second time you use it you need to select "re-use" and choose it from the list so that it only appears once on the reference list. After completing your edit please check this and also make sure that you added your citation properly.JenOttawa (talk) 22:19, 28 November 2021 (UTC)

2. Under Code Teams, after the sentence that reads “A number of "early warning" systems also exist which aim to quantify the person's risk of deterioration based on their vital signs and thus provide a guide to staff”, we propose adding the sentence “Rapid response can be divided into afferent and efferent parts. The afferent limb is the detection of a person at risk of deterioration and the efferent limb is the intervention implemented to resolve the problem.”

Thanks for sharing these. Can the terms afferent and efferent be wiki-linked? Many will not be familiar with this concept. Please be sure to add your citation using the "cite" tool as we practiced in class. @Marmariv: JenOttawa (talk) 22:19, 28 November 2021 (UTC)

Marmariv (talk) 21:15, 19 November 2021 (UTC)

References

Epidemiology

In this assignment, we are aiming to update some critical information to some statistics along with adding in a multinational perspective rather than focusing on an ethnocentric, US only perspective.

• To do this, we are aiming to update the first sentence, as it is an older source, with a more modern source. Currently US sudden cardiac deaths make up 20% of deaths, rather than the older source which is 15%.

Feedback: This looks good @Mbassi19:. You can add your citation after the punctuation (rather than mid-sentence). We also usually avoid using the term "currently" because people will not know when this edit was made on Wikipedia. We usually add in exact dates if you need to refer to timing, or avoid it completely. For example, you could say US sudden cardiac deaths make up 20%

• Secondly, we will add the incidence rates of sudden cardiac death for the US and compare it to South India and China, which represent two very different cultures, lifestyles, and populations and thus can give good global insight. The incidence of sudden cardiac death in the United States is 110.8 per 100,000, while China is 41.8 per 100,000 and South India is 39.7 per 100,000.

Feedback:Looks good. I usually tend to round my numbers to make it cleaner.JenOttawa (talk) 22:22, 28 November 2021 (UTC)

Mbassi19 (talk) 14:55, 18 November 2021 (UTC)

Society & Culture

We propose to adjust the following content in the Society and Culture section: (1) an updated definition of sudden cardiac arrest and sudden cardiac death, (2) a redefinition of the slang term ‘slow code’ as per the 2021 European Resuscitation Guidelines, (3) providing citations and examples of how ‘slow codes’ are banned in some jurisdictions, and (4) updating two citations within the section.

(Edit 1) We propose to alter the 2006 definition of cardiac arrest in the article to the 2021 definition; this is a minor change yet will bring credibility to the updated page.

Feedback: Great, thanks for sharing.JenOttawa (talk) 22:29, 28 November 2021 (UTC)

(Edit 2) Secondly, we propose to redefine the slang term for ‘slow code’, providing clarity on the deceptive nature of the practice. We plan to alter the sentence from:

• “In some medical facilities, the resuscitation team may purposely respond slowly to a person in cardiac arrest, a practice known as "slow code", or may fake the response altogether for the sake of the person's family, a practice known as "show code". This is generally done for people for whom performing CPR will have no medical benefit.

To an updated:

• “A ‘slow code’ is a slang term for the practice of deceptively delivering sub-optimal CPR to a person in cardiac arrest, when CPR is considered to have no medical benefit. A “show code” is the practice of faking the response altogether for the sake of the person’s family.”

Feedback- thanks for sharing this. Minor picky wikipedia edit is to ensure that citation comes after the punctuation (no spaces) like this.JenOttawa (talk) 00:50, 29 November 2021 (UTC)

(Edit 3) We noticed that the tone regarding ‘slow code’ improperly suggests that this practice is both common and generally more controversial than in reality; to counter this, a greater emphasis should be presented regarding the international prohibition of this ethically controversial practice. We plan on adding two sentences to the end of the slow code section to emphasize the current practice of slow codes. These are:

• “In 2021, the European Resuscitation Council Guidelines stated, “Clinicians should not partake in ‘slow codes’.”

And

• “The American College of Physicians ethics manual states, "because it is deceptive, physicians or nurses should not perform half-hearted resuscitation efforts."

This looks good. We usually avoid direct quotes in Wikipedia and try to paraphrase. I wonder if we could try this in this case. Could your first sentence be changed to: The European Resuscitation Council Guidelines has released a statement sharing that clinicians are suggested to participate/take part in ‘slow codes’. Do you want to try the other. Please feel free to change what I wrote, just ideas! Also, be sure to re-use the citation if it is used earlier in the article or in a different paragraph. You can re-use using the cite tool. Rather than pasting in your PMID/DOI into the cite tool, you click "re-use" and find the Perkins reference from the list.JenOttawa (talk) 22:29, 28 November 2021 (UTC)

(4) We noticed that citation 124 is an invalid hyperlink and should be altered to a proper dictionary citation. Secondly, citation 128 is an archived CPSO guideline and thus should be deleted along with the evidence or information shared from it.

Great, good catch. Thanks JenOttawa (talk) 22:29, 28 November 2021 (UTC)

References

Editor2299 (talk) 22:04, 18 November 2021 (UTC) and MeghanJenkins (talk) 22:04, 18 November 2021 (UTC)

Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): JSShin. Peer reviewers: Lindseyshehee.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 16:46, 16 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 25 October 2021 and 19 November 2021. Further details are available on the course page. Student editor(s): Kjlockart, Vsnguyen.em. Peer reviewers: ChrisHurtado7129, Joshua Cho28.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 18:39, 17 January 2022 (UTC)

Wiki Education assignment: WikiProject Medicine Winter 2024 UCF COM

This article was the subject of a Wiki Education Foundation-supported course assignment, between 8 January 2024 and 2 February 2024. Further details are available on the course page. Student editor(s): TRR2727 (article contribs).

— Assignment last updated by TRR2727 (talk) 21:26, 10 January 2024 (UTC)

General/Intro: - Review links to other articles. - Add references. - Clarify text.

Signs/Symptoms: - Provide list of common vs less common presentations and put into sentence rather than bullet form. - Clarify text about CPR and provide references.

Risk Factors: - Update references (some are dated) - Edit second paragraph for clarity. Text jumps from risks in children to smokers. - Third paragraph might merge with the first paragraph when talking about risk factors and structural changes to the heart.

Causes/Mechanisms: - Coronary Artery Disease, update references and statistics. - Check that ref.38 is appropriately cited here. - Provide clear definition of atherosclerosis. - Add references to non-atherosclerotic causes. - For structural heart diseases, update references some are from 2001, and provide new links for the examples. - There is one sentence about congestive heart failure, but more detail could be added. - Add a reference for the His/Purkinje system discussion. - Edit the text for mechanism

Diagnosis: - Discuss the physical exam and locations to check for pulse. - Find additional references for POCUS and discuss the views/angles, could add an image. - Expand the discussion of shockable vs non-shockable rhythms.

Prevention: - Not sure how code teams falls under prevention; find another place for this section to go. - Add new reviews for ICD section.

Management: - Update reference for ABCs - Unclear reason why the specific joules are mentioned for children. - Organize the paragraph about medications, maybe switch to bullet format for the specific drugs discussed. Make sure links are in place. - Separate paragraph for children management. - Provide abbreviations for ecmo and add additional detail.

Prognosis: - Edit for clarity and provide updated information where needed. — Preceding unsigned comment added by TRR2727 (talk • contribs) 22:19, 10 January 2024 (UTC)