Abstract
The Coronary Care Medicine department of St. Jans Hospital, Bruges, has a prehospital emergency medicine service (EMS) staffed by experienced intensive care specialists. We have been involved in clinical research for the improvement of cerebral outcome after circulatory arrest (CA) and cardiopulmonary resuscitation (CPR) since 1977. In 1982, 250 patients in CA were resuscitated in an area with a population of 150 000 people. There were 70 short-term survivals and 30 long-term survivals. Although the success rate of CPR is highly influenced by important EMS-related factors, including response time, a substantial proportion of hearts are restarted even after prolonged CA, but the patients die later of brain failure. There is still some doubt as to whether the brain is already damaged immediately after CA, or whether the lesion progresses after restoration of spontaneous circulation (ROSC) and is therefore amenable to therapy. As clinicians we prefer to believe the second hypothesis, of course.
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