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Original Article

Concept Analysis of Cardiac Arrest: Identifying the Critical Attributes and Empirical Indicators

Kang Im Lee1, Hyun Soo Oh2
Korean Journal of Adult Nursing 2014;26(5):573-583.
Published online: October 31, 2014

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Corresponding author: Lee, Kang Im Surgical Intensive Care Unit, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon 400-711, Korea. Tel: +82-10-2426-7941, Fax: +82-32-890-3999, E-mail: white-blue98@daum.net
• Received: May 25, 2014   • Accepted: October 6, 2014

Copyright © 2014 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    Cardiac arrest has multiple characteristics that need to be approached as an integrated method according to the various changes in the body system. This study was performed to develop a useful guideline for early detection of cardiac arrest by revealing the attributes of cardiac arrest through a concept analysis.
  • Methods
    This study was conducted according to the Walker and Avant's concept analysis method. Systematic literature review and in-depth interview with nurses who experienced cardiac arrest situation were conducted. Based on the literature reviews and in-depth interviews with nurses, the attributes and the empirical referents of the concept of cardiac arrest were elicited.
  • Results
    The definable attributes of cardiac arrest were 1) loss of consciousness, 2) abnormal respiratory condition, 3) abnormal cardiovascular signs. Cardiac arrest was found to occur by several antecedents such as cardiac problem, non-cardiac problem, or general problem, whereas ischemia and re-perfusion injury, which can lead to multiple organ failure and death, were derived as consequences.
  • Conclusion
    In this study, the concept analysis eliciting attributes and empirical referents is found to be useful as a guideline for understanding and managing cardiac arrest. Based on these findings, clinical providers are expected to make a precise and rapid decision on cardiac arrest and respond quickly, which may increase survival rate of the patients underwent the arrest event.
  • Key Words: Cardiac arrest; Concept analysis
Figure 1.
Flow diagram of literature selection process.
kjan-26-573f1.jpg
Figure 2.
Attributes, antecedents and consequences of cardiac arrest.
kjan-26-573f2.jpg
Table 1.
Attributes and Contents of Cardiac Arrest in Literature Review
Attributes Researches Contents
Unresponsiveness/ unconsciousness AHA (2010a, 2010c); Cho (2013); Christian, et.al (2011); ․ Tap the victim's shoulder & shout
Jun (2006); Jung & Chung (2010); KACPR (2011); "Are you all right?"
Kobayashi, et al. (2010); Kwon (2012); Nolan (2011); ․ No movement or response
On (2006); Ornato (2009); Sandroni, Nolan, Cavallaro,  
& Antonelli (2007); Yu, et al. (2007);  
Apnea AHA (2010a, 2010c); Cho (2013); Christian, et.al (2011); ․ Look, listen, and feel
Jun (2006); Jung & Chung (2010); Kobayashi, et al ․ No more than 10 sec to determine
(2010); Kwon (2012); Sandroni, Nolan, Cavallaro, &  
Antonelli (2007); Yu, et al. (2007);  
Agonal respiration Charles, et al. (2010); Cho (2013); Christian, et. al. ․ Abnormal breathing
(2011); Korea Centers for Disease Control & ․ Snorting, gurgling or gasping sound
Prevention (2011); Nolan (2011); Nolan, Soar, & ․ Irregular and sporadic
Perkins (2012); Ornato (2009); ․ Laboured or noisy breathing
Sandroni, Nolan, Cavallaro, & Antonelli (2007);  
Absence of detectable pulse AHA (2010a, 2010c); Jung & Chung (2010); Jun (2006); ․ Carotid pulse detect
Kim, Jun, Kim,& Choi (2008); Kobayashi, et al. (2010); ․ Femoral pulse detect
Kwon (2012); Ruzman, Tot, Ivic, Gulam, Rutman, & ․ No more than 10 sec to determine
Burazin, (2013); Sandroni, Nolan, Cavallaro, &  
Antonelli (2007); Yu, et al. (2007)  
Arrythmia AHA (2010a, 2010c); Kim, Lee, Lee, & Kim (2012); ․ Ventricular fibrillation
Korea Centers for Disease Control & Prevention ․ Pulseless ventricular tachycardia
(2011); Yu, et al. (2007) ․ Asystole
․ Pulseless electrical activity
Table 2.
Attributes of Cardiac Arrest in Field Work
Attributes Narrative
Unresponsiveness/ unconsciousness ․ "Suddenly the patient was fell down, and shown no response to verbal stimulation" (Subject 1)
․ "Patient showed no response to verbal stimulation, so I assessed pupil response and found that his pupil was dilated and fixed" (Subject 2)
․ "The monitor alarm was ringing, and I found that the patient was in unconsciousness state" (Subject 3)
Apnea ․ "The patient did not breathe, her lips were blue, and saturation level could not be monitored......" (Subject 3)
․ "Because most of ICU patients had ventilator, patients' apnea state might not be obvious for cardiac arrest" (Subject 7)
Absence of detectable pulse ․ "I could not feel the patient's femoral pulse, so I suspected that cardiac arrest was broken out" (Subject 4)
․ "I think carotid pulse must be palpated to confirm cardiac arrest, but I usually detect pulse from femoral artery" (Subject 5)
Arrhythmia ․ "EKG monitor alarm was ringing, so I checked monitor and found V-FIB. I immediately started to perform CPR." (Subject 6)
․ "EKG monitor alarm was ringing, and I found V-tac from the screen." (Subject 8)
․ "If I observed flatness of EKG, I usually made announcement for CPR" (Subject 9)
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  • Christian V., Manya L. C., Katarina B., James D., Maaret C.. 2011;In out-of hospital cardiac arrest patients, does the description of any specific symptoms to the emergency medical dispatcher improve the accuracy of the diagnosis of cardiac arrest:. A systematic review of the literature. Resuscitation. 82:1483–-1489.
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  • Korea Centers for Disease Control & Prevention. 2011;Development of guidelines for citizens' action to sudden cardiac arrest Retrieved June 30, 2013 from.http://www.cdc.go.kr/CDC/info/CdcKrInfo0210.jsp?menuIds=HOME001-MNU1155-MNU1083-MNU1375-MNU0566&cid=22002.
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    • Temporal patterns of change in vital signs and Cardiac Arrest Risk Triage scores over the 48 hours preceding fatal in‐hospital cardiac arrest
      HyunSoo Oh, KangIm Lee, WhaSook Seo
      Journal of Advanced Nursing.2016; 72(5): 1122.     CrossRef
    • Trend Analysis of Research in the Korean Journal of Adult Nursing for 5 Years (2010~2014): Focused on Usage of Nursing Theories
      Nam Kyung Han, Sanghee Kim, Myoung Shin Kim, Jong Gun Kim, Chang Hwan Kim, Seung Hye Choi
      Korean Journal of Adult Nursing.2015; 27(5): 527.     CrossRef

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    Korean J Adult Nurs. 2014;26(5):573-583.   Published online October 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.5.573
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    Concept Analysis of Cardiac Arrest: Identifying the Critical Attributes and Empirical Indicators
    Korean J Adult Nurs. 2014;26(5):573-583.   Published online October 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.5.573
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    • 1
    Concept Analysis of Cardiac Arrest: Identifying the Critical Attributes and Empirical Indicators
    Image Image
    Figure 1. Flow diagram of literature selection process.
    Figure 2. Attributes, antecedents and consequences of cardiac arrest.

    Figure 1.

    Figure 2.

    Concept Analysis of Cardiac Arrest: Identifying the Critical Attributes and Empirical Indicators

    Attributes and Contents of Cardiac Arrest in Literature Review

    Attributes Researches Contents
    Unresponsiveness/ unconsciousness AHA (2010a, 2010c); Cho (2013); Christian, et.al (2011); ․ Tap the victim's shoulder & shout
    Jun (2006); Jung & Chung (2010); KACPR (2011); "Are you all right?"
    Kobayashi, et al. (2010); Kwon (2012); Nolan (2011); ․ No movement or response
    On (2006); Ornato (2009); Sandroni, Nolan, Cavallaro,  
    & Antonelli (2007); Yu, et al. (2007);  
    Apnea AHA (2010a, 2010c); Cho (2013); Christian, et.al (2011); ․ Look, listen, and feel
    Jun (2006); Jung & Chung (2010); Kobayashi, et al ․ No more than 10 sec to determine
    (2010); Kwon (2012); Sandroni, Nolan, Cavallaro, &  
    Antonelli (2007); Yu, et al. (2007);  
    Agonal respiration Charles, et al. (2010); Cho (2013); Christian, et. al. ․ Abnormal breathing
    (2011); Korea Centers for Disease Control & ․ Snorting, gurgling or gasping sound
    Prevention (2011); Nolan (2011); Nolan, Soar, & ․ Irregular and sporadic
    Perkins (2012); Ornato (2009); ․ Laboured or noisy breathing
    Sandroni, Nolan, Cavallaro, & Antonelli (2007);  
    Absence of detectable pulse AHA (2010a, 2010c); Jung & Chung (2010); Jun (2006); ․ Carotid pulse detect
    Kim, Jun, Kim,& Choi (2008); Kobayashi, et al. (2010); ․ Femoral pulse detect
    Kwon (2012); Ruzman, Tot, Ivic, Gulam, Rutman, & ․ No more than 10 sec to determine
    Burazin, (2013); Sandroni, Nolan, Cavallaro, &  
    Antonelli (2007); Yu, et al. (2007)  
    Arrythmia AHA (2010a, 2010c); Kim, Lee, Lee, & Kim (2012); ․ Ventricular fibrillation
    Korea Centers for Disease Control & Prevention ․ Pulseless ventricular tachycardia
    (2011); Yu, et al. (2007) ․ Asystole
    ․ Pulseless electrical activity

    Attributes of Cardiac Arrest in Field Work

    Attributes Narrative
    Unresponsiveness/ unconsciousness ․ "Suddenly the patient was fell down, and shown no response to verbal stimulation" (Subject 1)
    ․ "Patient showed no response to verbal stimulation, so I assessed pupil response and found that his pupil was dilated and fixed" (Subject 2)
    ․ "The monitor alarm was ringing, and I found that the patient was in unconsciousness state" (Subject 3)
    Apnea ․ "The patient did not breathe, her lips were blue, and saturation level could not be monitored......" (Subject 3)
    ․ "Because most of ICU patients had ventilator, patients' apnea state might not be obvious for cardiac arrest" (Subject 7)
    Absence of detectable pulse ․ "I could not feel the patient's femoral pulse, so I suspected that cardiac arrest was broken out" (Subject 4)
    ․ "I think carotid pulse must be palpated to confirm cardiac arrest, but I usually detect pulse from femoral artery" (Subject 5)
    Arrhythmia ․ "EKG monitor alarm was ringing, so I checked monitor and found V-FIB. I immediately started to perform CPR." (Subject 6)
    ․ "EKG monitor alarm was ringing, and I found V-tac from the screen." (Subject 8)
    ․ "If I observed flatness of EKG, I usually made announcement for CPR" (Subject 9)
    Table 1. Attributes and Contents of Cardiac Arrest in Literature Review

    Table 2. Attributes of Cardiac Arrest in Field Work

    Table 1.

    Table 2.

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