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2017 ; 4
(3
): 227-234
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Cardiocerebral and cardiopulmonary resuscitation - 2017 update
#MMPMID29123868
Ewy GA
Acute Med Surg
2017[Jul]; 4
(3
): 227-234
PMID29123868
show ga
Sudden cardiac arrest is a major public health problem in the industrialized
nations of the world. Yet, in spite of recurrent updates of the guidelines for
cardiopulmonary resuscitation and emergency cardiac care, many areas have
suboptimal survival rates. Cardiocerebral resuscitation, a non-guidelines
approach to therapy of primary cardiac arrest based on our animal research, was
instituted in Tucson (AZ, USA) in 2002 and subsequently adopted in other areas of
the USA. Survival rates of patients with primary cardiac arrest and a shockable
rhythm significantly improved wherever it was adopted. Cardiocerebral
resuscitation has three components: the community, the pre-hospital, and the
hospital. The community component emphasizes bystander recognition and chest
compression only resuscitation. Its pre-hospital or emergency medical services
component emphasizes: (i) urgent initiation of 200 uninterrupted chest
compressions before and after each indicated single defibrillation shock, (ii)
delayed endotracheal intubation in favor of passive delivery of oxygen by a
non-rebreather mask, (iii) early adrenaline administration. The hospital
component was added later. The national and international guidelines for
cardiopulmonary resuscitation and emergency medical services are still not
optimal, for several reasons, including the fact that they continue to recommend
the same approach for two entirely different etiologies of cardiac arrest:
primary cardiac arrest, often caused by ventricular fibrillation, where the
arterial blood oxygenation is little changed at the time of the arrest, and
secondary cardiac arrest from severe respiratory insufficiency, where the
arterial blood is severely desaturated at the time of cardiac arrest. These
different etiologies need different approaches to therapy.
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