Respiratory arrest

• Respiratory arrest:

  • Absence of breathing
  • Usually the end point of respiratory distress that leads to respiratory failure
  • If left untreated, will lead to cardiac arrest
• Respiratory arrest (and impaired respiration that can progress to respiratory arrest) can be caused by

  • Airway obstruction
  • Decreased respiratory effort
  • Respiratory muscle weakness
• Upper airway obstruction may be caused by any object or substance that blocks the oropharynx, including

  • Blood
  • Mucus
  • Vomitus
  • Foreign body
  • Spasm of the vocal cords
  • Edema of the vocal cords
  • Pharyngolaryngeal or tracheal inflammation (eg, epiglottitis, croup)
  • Posterior portion of the tongue in patients with decreased consciousness
  • Tumor
  • Trauma
• Lower airway obstruction may result from

  • Aspiration
  • Bronchospasm
  • Airspace filling disorders (eg, pneumonia, pulmonary edema, pulmonary hemorrhage)
  • Drowning
• Decreased respiratory effect:

  • CNS disorder - stroke, infection, tumour, cervical spine injury
  • Adverse effect of medications or illicit drugs - opioids, sedatives
  • Metabolic disorder - hypoglycaemia
  • Obesity - obesity hypoventilation syndrome
  • Mechanical defects - kyphyoscoliosis, phrenic nerve damage, neuromuscular disorders
• Respiratory muscle weakness:

  • Respiratory muscle fatigue
  • Neuromuscular diseases
  • Corticosteroids or neuromuscular-blocking medications
• Management:

  • Clearing the airway if obstructed
  • Establishing an alternate airway e.g. LPA
  • Mechanical ventilation - aim for breath every 5-6 seconds (10-12 breaths per minute)