T HIS discussion concerns the resuscitation of patients who die in the operating room. The type of death under discussion is that which occurs unexpectedly. It occurs in the patient who possesses normaI heart and lungs. Its occurrence in a healthy patient is not unhke turning off the ignition in a good motor. A vita1 spark is lost in an otherwise good mechanism. FortunateIy, this type of death does not occur frequentIy. When it does occur, however, the stake is high. I can recaI1 severa instances in my own experience. The Hurst one happened twenty years ago when I was a surgica1 intern in one of the hospitaIs in BaItimore. A puImotor was brought to the operating room by the Iire department. The patient couId not be revived. Unsuccessfu1 attempts at resuscitation take pIace in the operating rooms the worId over. My beIief is that surgeons shouId not turn these emergencies over to the care of the fire department. We shouId take care of them ourselves. To do so requires a program of action established before the emergency occurs and put into use as soon as the emergency appears. Training in resuscitation shouId become a part of the surgical curriculum. In order to take care of these emergencies we must have a proper appreciation of the oxygen requirements to sustain cel1 life for which an aImost constant supply of oxygen is necessary. The supply of oxygen can be interrupted for only a few minutes and then the flame of Iife goes out. Life can be restored if the interruption in the oxygen system is brief. The safe period for the human being is not definiteIy known but anima1 experimentation places it at three to five minutes.l The respiratory center rapidly Ioses its function if it is deprived of oxygen for Ionger periods of time. If respiratory function can be restored Iater on, resuscitation is possible. If it cannot be restored Iater on, then, of course, fuI1 recovery is impossibIe even though the heart action has been restored. Effective effort must be made to re-estabIish the oxygen system before respiratory Ioss becomes permanent. There is no place here for tria1 and error experimentation. When the emergency arises, proper steps must be taken without deliberation and deIay. The Oxygen System. The oxygen system incIudes respiration and circuIation. (Fig. I .) These two components are interdependent in transporting oxygen to the living cell. Whether respiration faiIs Hurst or whether circuIation faiIs first is of Iittle consequence in resuscitation. The Ioss of either is equalIy destructive to the suppIy of oxygen to the cel1 and to ceI1 life. Respiration. The Iungs must be ventiIated properIy for successfu1 resuscitation. The methods of Schaefer and of SyIvester are vaIuabIe for resuscitation from drowning and can be used anywhere in the open country. However, these boy-scout methods of chest compression do not meet the demands of resuscitation in the operating room. Likewise the Drinker respirator is not satisfactory for this purpose. A constant stream of oxygen deIivered into the Iungs through an intratrachea1 catheter does not provide satisfactory ventiIation of