Diseases

Respiratory arrest – causes, symptoms & treatment

Apnea

Respiratory arrest or apnea is a complete cessation of external breathing. Respiratory arrest can have many different causes, ranging from voluntary interruption to illness to certain trauma or neurotoxin poisoning. Breathing arrest becomes critical after just a few minutes due to the onset of insufficient oxygen supply.

What is respiratory arrest?

A complete cessation of external breathing is called respiratory arrest or apnea. The cessation of breathing can be voluntary, simply by holding your breath, or it can be caused by external factors. In the case of an involuntary arrest of breathing, either the breathing reflex is temporarily or permanently disturbed, or the respiratory muscles are paralyzed. In the vast majority of cases, the apnea is caused by traumatic brain injury (TBI).

Breathing can also be interrupted by a mechanical blockage of the airways, such as in sleep apnea . The gas exchange in the capillaries of the pulmonary alveoli, like the gas exchange in the capillaries within the tissue, initially remains for a short time.

Only after the oxygen in the remaining amount of air in the lungs has been used up does the exchange of carbon dioxide for molecular oxygen and vice versa come to a standstill. This not only results in an undersupply of oxygen (hypoxia), but also in a dangerous overconcentration of carbon dioxide, which causes hyperacidity .

causes

A respiratory arrest can have a variety of reasons that require different measures to correct the problem. By far the most common causes are obstructive sleep apnea syndrome and what is known as traumatic brain injury (TBI). Obstructive sleep apnea is a blockage in the upper airways during sleep.

The circular smooth muscle around the upper airways relaxes so much that the upper part of the trachea mutates into a tube with tension-free walls. The slight negative pressure created when you breathe in causes the walls to “collapse”, creating the blockage. TBI, which can result from an accident, is usually accompanied by loss of consciousness and the loss of many brain functions. In more severe cases, the respiratory center can also be so disturbed that the respiratory reflex fails to appear and respiratory arrest sets in.

Paralysis of the respiratory muscles due to illness or poisoning with neurotoxins can also lead to respiratory arrest. A blow to the solar plexus nerve network through an accident or other violent effects can trigger a reflex that causes the respiratory muscles to spasm, leading to a (usually) temporary arrest of breathing.

Symptoms, Ailments & Signs

External signs of respiratory arrest include loss of consciousness , no airflow through the nose or mouth, dilated pupils , and a slight blue discoloration of the skin ( cyanosis ) that becomes apparent after a few minutes. A persistent respiratory arrest initially leads to a lack of oxygen ( hypoxia ), which also irreversibly damages the internal organs and the brain, so that the person concerned can die of organ failure. Sometimes, various symptoms such as headaches , nausea , but also sometimes euphoria and overconfidence are possible. These are symptoms typically seen in altitude sickness.

In the worst case, those affected can die if the respiratory arrest is not treated in time. Even with treatment, in some cases the brain can be so badly damaged that people suffer from reduced intelligence or other disabilities and mental health problems due to the cessation of breathing.

This significantly reduces the patient’s quality of life. If the apnea lasts for about ten minutes, the patient dies in most cases. Mouth-to-mouth resuscitation can prevent death until the emergency doctor arrives.

Diagnosis & History

This leads to a rapid increase in the carbon dioxide concentration in the blood, which is intended to trigger the maximum stimulus in the respiratory center to trigger a spontaneous breath. The lack of oxygen is accompanied by a dangerous increase in the concentration of carbon dioxide in the blood during prolonged respiratory arrest, which usually triggers a strong respiratory reflex.

Remarkably, if the carbon dioxide concentration increases even further, the respiratory reflex again weakens and stops altogether. As the disease progresses, symptoms of poisoning and irreversible damage to the nerve cells in the brain appear. If no immediate countermeasures are taken, death by asphyxiation is inevitable.

If this does not occur, there is a total failure of the respiratory center, an important criterion for determining brain death. For example, one of the ultimate tests of suspected brain death is to ventilate the person who is unable to breathe with pure oxygen while reducing the ventilation.

complications

A respiratory arrest must be treated directly by a doctor or in the hospital. If left untreated, respiratory arrest is fatal in most cases. Death occurs when the brain and other organs are deprived of oxygen for too long and become severely damaged.

If a patient has suffered respiratory arrest and is then ventilated again, the degree of injury is highly dependent on how long the organs have been deprived of oxygen. If you stop breathing for a short time, it is assumed that most organs will not be damaged. After that, the brain functions without much difficulty. After stopping breathing, the patient complains of severe headaches and nausea .

If the respiratory arrest lasts longer, the brain will be damaged. After that, certain parts of the brain can no longer function properly, which can lead to thinking disorders. It is not uncommon for the brain to no longer be able to properly control certain parts of the body. If the respiratory arrest lasts even longer, this usually leads to death and also to cardiac arrest . CPR must be performed promptly to avoid organ damage.

When should you go to the doctor?

When man stops breathing, his life is in grave danger. Any apnea is therefore a reason to call the emergency doctor and to have the cause clarified after the necessary rescue measures. At best, in the event of a respiratory arrest, one person provides first aid while another calls the ambulance, because if the patient is not helped immediately, he or she may die within minutes due to lack of oxygen.

Even if he survives the apnea or starts breathing again on his own, it is questionable how extensive the damage to the brain is after a long time. The person may wake up severely disabled or unable to wake up at all, even when breathing again.

Many respiratory arrests do not happen in such dramatic situations at all, but are only of short duration and are sometimes not consciously noticed – for example in cases of sleep apnea. Nevertheless, they are just as dangerous as in any other case. In the case of sleep apnea, however, the emergency doctor does not have to be called immediately, as those affected start breathing again on their own.

However, a medical examination must still be carried out in order to avoid really dangerous situations and to stop the nocturnal apnea. Sudden cessation of breathing is the trigger for sudden infant death in infants and small children, which is why children at risk, such as premature babies, should be monitored by a doctor as a precaution.

Treatment & Therapy

The many causes of apnea require immediate action to remedy the apnea or – if this is not possible – to avoid it. When treating apnea, which is a life-threatening situation, urgency is of the essence as serious health damage can occur within minutes. If the apnea is caused by mechanical obstruction of the upper airway by foreign objects, removal of the foreign objects provides immediate relief.

If removal is not possible, immediate tracheotomy (cricothyrotomy) below the larynx can be life-saving. The same measure may also be necessary for allergic reactions to an insect bite in the throat, when the swelling of the tissue closes the trachea tightly. In the many cases in which respiratory arrest is coupled with cardiovascular failure, resuscitation measures are necessary.

The measures range from simple chest compressions coupled with mouth-to-mouth resuscitation to the use of a defibrillator and injections or infusions. The cardiac massage , which is carried out at a frequency of about 100 to 120 per minute by rhythmic pressure on the breastbone , should be replaced by 2 ventilation attempts after about 30 pressures.

In the case of a respiratory arrest caused by neurotoxins, narcotics or intoxicants, in addition to resuscitation measures in certain cases such as snake bites or mushroom poisoning , countermeasures are available which, at best, neutralize the toxins. In the presence of certain neurological diseases that cause permanent impairment of natural breathing, permanent active ventilation using suitable devices may be necessary.

Outlook & Forecast

The outlook and prognosis for a respiratory arrest depends on the exact cause of the respiratory arrest and how quickly breathing resumes. On the other hand, if breathing stops at all, the result is suffocation after a few minutes. A subsequent attempt at resuscitation may still be successful after several minutes, but will result in severe and irreversible brain damage in almost all cases. These occur after just three minutes without an oxygen supply and can affect all areas of the brain.

Lack of oxygen as a result of suspended breathing quickly leads to hypoxemia and subsequent organ and brain damage. Occasional pauses in breathing for a few seconds are normal for many people (in the context of sleep apnea, for example) and have no acute damaging effect. However, long-term damage caused by a recurring brief lack of oxygen is possible.

Apnea due to mechanical causes (strangulation, choking, etc.) can usually be resolved by removing the trigger. Organic causes – in particular nerve and muscle damage – in the event that they bring breathing to a standstill, usually mean that the person concerned can no longer initiate breathing himself. Until the causative disease is cured, he is initially dependent on artificial respiration.

In general, the faster a person who has stopped breathing – regardless of the cause – is ventilated, the better the prognosis in terms of consequential damage. Breathing arrests that are not due to a complete organic failure can therefore be bridged until the cause is found.

prevention

Due to the variety of possible causes of respiratory arrest, preventive measures that could prevent respiratory arrest are hardly possible. General preventive measures are to keep yourself healthy and not to abuse alcohol or other drugs.

aftercare

Whether follow-up treatment is necessary as a result of a respiratory arrest depends primarily on the cause. Neurological diseases and damage to the respiratory muscles can always cause the well-known symptoms. In these cases, a renewed presentation to the doctor is essential. The situation is different, however, when acute causes cause the respiratory arrest.

An electrical accident or strangulation cannot be expected again. Therefore, a recurrence can be ruled out, which is why follow-up examinations are not necessary after a complete recovery. Sometimes the symptoms of respiratory arrest cannot be treated at all. This is particularly the case when breathing stops for a long period of time.

As described above, the brain is damaged. This means that certain organs can no longer be controlled properly. Complications such as respiratory arrest can occur again and again. Affected people must therefore regularly come to a doctor for follow-up care.

In order to live a symptom-free life in everyday life, patients can receive help to reduce the factors that promote an illness. In general, you should stay away from nicotine, alcohol and drugs. Follow-up care may also include training family members on how to resuscitate a patient who has stopped breathing.

You can do that yourself

In the event of respiratory arrest, first aid measures must be taken immediately. If necessary, the affected person must be removed from the danger zone before further treatment takes place. The patient is best placed in a stable side position and sedated.

If necessary, resuscitation measures such as mouth-to-mouth resuscitation must be carried out directly on site. In addition, the emergency doctor should be alerted immediately. Based on the W-questions, the emergency services must be given all the relevant information so that immediate treatment is possible.

Further self-measures depend on the cause of the respiratory arrest. If a foreign body is the cause, it must be carefully removed from the mouth or throat. The head should be turned to the side so that vomit can drain off. If pollutants or toxins are suspected to be the cause, rescue breathing should not be performed.

Cardiopulmonary resuscitation is more useful in this case. After the initial apnea has been treated, rest and bed rest are of primary importance . The affected person should recover for a few days and then slowly return to everyday life. In a conversation with a therapist , the respiratory arrest can be worked through in order to avoid the development of psychological problems.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.