Cardiopulmonary resuscitation: State of the art

Abstract

HE COMBINED procedures of positive-pressure ventilation, closed-chest precordial compression, and electrical defibrillation, which constitute the conventional components of cardiopulmonary resuscitation (CPR), were introduced into clinical practice 30 years ago.*J Because of the simplicity and noninvasiveness of these techniques, they were rapidly implemented and, in the past two decades, almost universally used by both professional providers and lay bystanders. However, there has been increasing concern with the hemodynamic efficacy of these conventional methods of CPR. The success rate is as low as 5% and even less after protracted cardiac arrest.3 Accordingly, other options for CPR have been investigated in an effort to develop alternative techniques that might improve both resuscitability and long-term, meaningful survival. Open-chest direct cardiac massage actually preceded closed-chest precordial compression,4 and there is little doubt that it is more effective for initial cardiac resuscitation though not necessarily of proven benefit for improved survivability. Extracorporeal circulation is even more effective for initial resuscitation, but, again, unproven with respect to its capability to increase ultimate survival. In addition, vasopressor agents, calcium salts, vagolytic drugs, antiarrhythmic agents, and buffer solutions are cited as potentially beneficial when they supplement the physical interventions during CPR. In this review, basic principles and the status of current clinical and experimental interventions for CPR are covered.