New insights into effective CPR: cardiocerebral resuscitation for primary cardiac arrest.
Cardiocerebral resuscitation is a new approach to patients with primary cardiac arrest that has been shown to dramatically increase survival. The term cardiocerebral is used to stress that the issue is immediate and effective support of the central circulation. Cardiocerebral resuscitation consists of continuous chest compressions--without mouth-to-mouth ventilations--administered by bystanders, and a new algorithm for emergency medical services that consists of sets of 200 chest compressions before and immediately after electrocardiographic analysis and, if indicated, a single shock. Ventilation is initially provided by passive oxygen insufflation rather than with intubation or bag-mask ventilation. Early establishment of intravenous or intraosseous access for epinephrine is emphasized. Postresuscitation care for comatose patients includes early coronary intervention and 24 hours of mild hypothermia. Studies show marked improvement in prehospital cardiac arrest patients with return of spontaneous circulation who subsequently received specialized postresuscitation care.
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Gordon A
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University of Arizona Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA.
D000465:Algorithms; D016887:Cardiopulmonary Resuscitation; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002560:Cerebrovascular Circulation; D002985:Clinical Protocols; D003128:Coma / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D003131:Combined Modality Therapy; D003326:Coronary Circulation; D004554:Electric Countershock; D004562:Electrocardiography; D004632:Emergency Medical Services; D004837:Epinephrine / Q000008:administration & dosage; D006323:Heart Arrest / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D007327:Insufflation; D010102:Oxygen Inhalation Therapy; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods*; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D004837:Epinephrine