Is Glibenclamide the New Cool in Cardiopulmonary Resuscitation?*

Abstract

The history of cardiopulmonary resuscitation (CPR) for cardiac arrest is a 300-year long story of one major success after another.1 It was during the Enlightenment, when scholars were attempting to scientifically solve the problem of sudden death, that the various components of CPR—ventilation, circulation, electricity, and organization of emergency medical services—began to take shape. The 19th century gave way to landmark advances in both ventilatory support—intubation innovations and artificial respirators—and in the open-and closed chest circulatory support. More recently, ventricular fibrillation and novel defibrillation techniques were described. In 1960, mouth-to-mouth resuscitation was combined with chest compression and defibrillation. Recent decades have witnessed huge advances in cardiovascular pharmacotherapy that have evolved into the life-saving treatments we now take as routine. Together, innumerable groundbreaking discoveries during the last three centuries have led to the scientific framework for CPR as we know it today. But, since the Enlightenment, CPR has been mostly about the heart, not the brain, whereas arguably, the brain is the organ most vulnerable to cardiac arrest. Only recently have we begun to apply interventions directed specifically at preserving brain function and improving neurological outcome.2