Abstract
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.
Highlights
C ARDIOVASCULAR DISEASES CONTINUE to be the leading cause of death in most industrialized nations of the world.[1,2] the first sign of cardiovascular disease is often the last, as the first sign is often sudden cardiac arrest
O UR UNIVERSITY OF Arizona cardiopulmonary resuscitation (CPR) Resuscitation Research Group published six studies with a total of 169 swine with variable durations of ventricular fibrillation (VF) arrest before the initiation of basic life support with: (i) compression only CPR” (CO-CPR), (ii) guidelines CPR with ventilations delivered over a 4-s period, or (iii) no CPR for several minutes to simulate the lack of bystander CPR and the late arrival of emergency medical services personnel (EMS).[29]
I T TOOK US years of laboratory research to discover the importance of CO-CPR for myocardial perfusion and survival, but it took me listening to one recording of an emergency dispatcher’s conversation between a wife receiving telephone CPR instructions to appreciate the deleterious effects of even short interruptions of chest compressions to cerebral perfusion
Summary
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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