The primacy of basics in advanced life support.
OBJECTIVE
The standards required for optimal effect of chest compressions and the degree to which most practice falls short of ideal have not been widely appreciated. This review highlights some of the important data now available and offers a haemodynamic explanation that broadens current concepts.


RESULTS
New techniques have permitted a detailed examination of how compressions are performed in practice. The implications of recent experimental work adds a new imperative to the need for improvement.


CONCLUSIONS
In addition to highlighting the need for improved training and audit, the greater understanding of mechanisms in resuscitation suggest that guidelines for management of adult cardiac arrest of presumed cardiac origin need further revision and simplification.
Chamberlain
Douglas
D
South East Coast Ambulance NHS Trust, Lewes, East Sussex, UK. dac@dachamberlain.co.uk
Frenneaux
Michael
M
Fletcher
David
D
D022561:Advanced Cardiac Life Support / Q000592:standards*; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D035641:Chest Wall Oscillation / Q000592:standards*; D006323:Heart Arrest / Q000628:therapy; D006439:Hemodynamics / Q000502:physiology; D006801:Humans