Current concepts in cardiopulmonary resuscitation.
For many people cardiac arrest is a natural ending of a long and productive life. A substantial number of humans, however, are struck by this event too early in life with tragic consequences including financial problems for both family and society. A recent review of in-hospital cardiac arrests found a wide variation in the reported survival to discharge ranging from 0% to 28.9% with a mean of 14%1. This is largely explained by underlying diseases. In out-of-hospital cardiac arrests the survival to discharge is similar2, 3. fewer than 3% of cardiac arrest victims leave the hospital alive and return to productive lives. The reasons for these depressing results are multifactorial including rapidity and sequence with which the resuscitation interventions are delivered. Bystander CPR is an important link in "the chain of survival" before more advanced interventions will be available at the scene. 4 CPR training programmes for lay people have been organised in many countries with millions of people trained in basic CPR. It is important to continue this education of lay people since at the moment early bystander CPR, besides defibrillation, is probably the single most important intervention. The concept of early activation of the emergency medical System, early basic life support (BLS), including precordial compression and artificial ventilation, early defibrillation, and early advanced cardiac life support (ACLS), could achieve 25-40% survival rates.3 These concepts for emergency cardiac care have been supported by the American Heart Association5 as well as the European Resuscitation Counil.6 Advanced cardiac life support protocols combine pharmacological and mechanical interventions to restore spontaneous circulation (ROSC) and is based on four components: early defibrillation, administration of drugs, ventilation (oxygenation), and circulatory support.
Rubertsson
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Department of Cardiac Anaesthesiology and Intensive Care, Uppsala, University Hospital, S-751 85 Upssala, Sweden. sten.rubertsson@anestesi.uu.se.