Cardiopulmonary resuscitation: a review for clinicians.

Attempts at cardiopulmonary resuscitation (CPR) date from antiquity, but it is only in the last 50 years that a scientifically-based methodology has been developed. External chest compressions is the standard method for managing circulatory arrest, however, numerous alterations of this technique have been proposed in attempts to improve outcome from CPR. Defibrillation is the single most important therapy for the management of ventricular fibrillation or pulseless ventricular tachycardia. Adrenergic agents used to improve myocardial and cerebral perfusion are also the subject of considerable investigation with new agents entering clinical study. This paper reviews the history, current techniques and pharmacotherapy as well as controversial issues in the management of patients with cardiac arrest.

[1]  M. Weil,et al.  Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. , 1986, The New England journal of medicine.

[2]  H. Stueven,et al.  Calcium chloride: reassessment of use in asystole. , 1984, Annals of emergency medicine.

[3]  D. Randall,et al.  8 - Special Techniques , 1971 .

[4]  H. Liss.  A history of resuscitation. , 1986, Annals of emergency medicine.

[5]  High-dose epinephrine in adult cardiac arrest. , 1992, The New England journal of medicine.

[6]  T. Aufderheide,et al.  Prehospital experience with defibrillation of coarse ventricular fibrillation: a ten-year review. , 1990, Annals of emergency medicine.

[7]  R. Hamlin,et al.  The effect of norepinephrine versus epinephrine on regional cerebral blood flow during cardiopulmonary resuscitation. , 1989, The American journal of emergency medicine.

[8]  J. Tulsky,et al.  Cardiopulmonary resuscitation on television. Miracles and misinformation. , 1996, The New England journal of medicine.

[9]  C. Rattenborg.  Effect of Bicarbonate and THAM on Apnea-Induced Hypercarbia , 1977 .

[10]  M. Eisenberg,et al.  SENSITIVITY, ACCURACY, AND SAFETY OF AN AUTOMATIC EXTERNAL DEFIBRILLATOR Report of a Field Evaluation , 1984, The Lancet.

[11]  M. Callaham,et al.  A randomized clinical trial of active compression-decompression CPR vs standard CPR in out-of-hospital cardiac arrest in two cities. , 1995, JAMA.

[12]  R. V. Lee.  Cardiopulmonary resuscitation in the eighteenth century. A historical perspective on present practice. , 1972, Journal of the history of medicine and allied sciences.

[13]  A. Hallstrom,et al.  Automatic external defibrillators: clinical, training, psychological, and public health issues. , 1985, Annals of emergency medicine.

[14]  L. Bossaert,et al.  Quality and efficiency of bystander CPR , 1993 .

[15]  K. Lindner,et al.  Comparison of standard and high‐dose adrenaline in the resuscitation of asystole and electromechanical dissociation , 1991, Acta anaesthesiologica Scandinavica.

[16]  C. Beck,et al.  Ventricular fibrillation of long duration abolished by electric shock. , 1947, Journal of the American Medical Association.

[17]  J. Ornato,et al.  Dose-dependent vasopressor response to epinephrine during CPR in human beings. , 1989, Annals of emergency medicine.

[18]  P. Pepe,et al.  A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. The Multicenter High-Dose Epinephrine Study Group. , 1992, The New England journal of medicine.

[19]  B. Wiggs,et al.  Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. , 1990, Annals of internal medicine.

[20]  T. Lukens,et al.  A prospective study of femoral versus subclavian vein catheterization during cardiac arrest. , 1990, Annals of emergency medicine.

[21]  Russell Es.  Cardiac arrest. A. Survival after 21/2 hours' open chest cardiac massage. B. Survival after closed chest cardiac massage. , 1962 .

[22]  Effect of injection site on circulation times during cardiac arrest. , 1988, Critical care medicine.

[23]  E. Glucksman,et al.  Training St John Ambulance volunteers to use an automated external defibrillator. , 1994, Resuscitation.

[24]  T. J. Appleton,et al.  Simultaneous aortic, jugular bulb, and right atrial pressures during cardiopulmonary resuscitation in humans. Insights into mechanisms. , 1989, Circulation.

[25]  C. Robertson.  The value of open chest CPR for non-traumatic cardiac arrest. , 1991, Resuscitation.

[26]  M. Kelley,et al.  Survival after in-hospital cardiopulmonary arrest of noncritically ill patients. A prospective study. , 1994, Chest.

[27]  M. Copass,et al.  Amplitude of ventricular fibrillation waveform and outcome after cardiac arrest. , 1985, Annals of internal medicine.

[28]  H. Drexler,et al.  Contrasting peripheral short-term and long-term effects of converting enzyme inhibition in patients with congestive heart failure. A double-blind, placebo-controlled trial. , 1989, Circulation.

[29]  Kerber Re.  Energy requirements for defibrillation. , 1986 .

[30]  C. Barton,et al.  A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard-dose epinephrine in prehospital cardiac arrest. , 1992, JAMA.

[31]  H. Halperin,et al.  Vest inflation without simultaneous ventilation during cardiac arrest in dogs: improved survival from prolonged cardiopulmonary resuscitation. , 1986, Circulation.

[32]  S. David,et al.  Sustained consciousness during ventricular fibrillation: case report of cough cardiopulmonary resuscitation. , 1996, Catheterization and cardiovascular diagnosis.

[33]  A. Cohen,et al.  Hemodynamics of cough cardiopulmonary resuscitation in a patient with sustained torsades de pointes/ventricular flutter. , 1994, The Journal of emergency medicine.

[34]  P. Safar,et al.  Amelioration of brain damage after 12 minutes' cardiac arrest in dogs. , 1976, Archives of neurology.

[35]  J. Varon,et al.  Automated external versus blind manual defibrillation by untrained lay rescuers. , 1997, Resuscitation.

[36]  W. Cascio,et al.  Intravenous amiodarone during prolonged resuscitation from cardiac arrest. , 1989, Annals of internal medicine.

[37]  G. Crile,et al.  AN EXPERIMENTAL RESEARCH INTO THE RESUSCITATION OF DOGS KILLED BY ANESTHETICS AND ASPHYXIA , 1906, The Journal of experimental medicine.

[38]  R. Hamlin,et al.  Myocardial oxygen delivery/consumption during cardiopulmonary resuscitation: a comparison of epinephrine and phenylephrine. , 1988, Annals of emergency medicine.

[39]  A. Laupacis,et al.  The Ontario trial of active compression-decompression cardiopulmonary resuscitation for in-hospital and prehospital cardiac arrest. , 1996, JAMA.

[40]  R. Kerber,et al.  Factors affecting transthoracic impedance during electrical cardioversion. , 1988, The American journal of cardiology.

[41]  W. Dick,et al.  Comparison of blood gases of ventilated patients during transport , 1987, Critical care medicine.

[42]  T. Sawada,et al.  MASS SCREENING FOR NEUROBLASTOMA IN INFANTS IN JAPAN Interim Report of a Mass Screening Study Group , 1984, The Lancet.

[43]  A. Aitkenhead.  Drug administration during CPR: what route? , 1991, Resuscitation.

[44]  K. Stults,et al.  Prehospital defibrillation performed by emergency medical technicians in rural communities. , 1984, The New England journal of medicine.

[45]  D. Roberts,et al.  Early predictors of mortality for hospitalized patients suffering cardiopulmonary arrest. , 1990, Chest.

[46]  M. Weil,et al.  Augmented Efficacy of External CPR by Intermittent Occlusion of the Ascending Aorta , 1993, Circulation.

[47]  M. Brodsky,et al.  Magnesium sulfate therapy for sustained monomorphic ventricular tachycardia. , 1989, The American journal of cardiology.

[48]  M H Weil,et al.  Cardiopulmonary resuscitation: a historical review. , 1986, Acute care.

[49]  G. Lombardi,et al.  Outcome of Out-of-Hospital Cardiac Arrest in New York City: The Pre-Hospital Arrest Survival Evaluation (PHASE) Study , 1994 .

[50]  G A Ewy,et al.  Myocardial perfusion pressure: a predictor of 24-hour survival during prolonged cardiac arrest in dogs. , 1988, Resuscitation.

[51]  J Barrett,et al.  Outcome of CPR in a large metropolitan area--where are the survivors? , 1991, Annals of emergency medicine.

[52]  M. Chin,et al.  Active compression-decompression. A new method of cardiopulmonary resuscitation. Cardiopulmonary Resuscitation Working Group. , 1992, JAMA.

[53]  R. Nowak,et al.  Comparison of central venous and arterial pH and PCO2 during open-chest CPR in the canine model. , 1984, Annals of emergency medicine.

[54]  K. Lindner,et al.  Epinephrine versus norepinephrine in prehospital ventricular fibrillation. , 1991, The American journal of cardiology.

[55]  J. B. Sack,et al.  Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. , 1992, JAMA.

[56]  W. Black,et al.  Sudden cardiac death: etiologies, pathogenesis, and management. , 1989, Disease-a-month : DM.

[57]  J. Criley,et al.  Cough-induced cardiac compression. Self-administered from of cardiopulmonary resuscitation. , 1976, JAMA.

[58]  K. Lindner,et al.  Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation , 1997, The Lancet.

[59]  C. Leon,et al.  Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. , 1990, Resuscitation.

[60]  M. Weil,et al.  Myocardial dysfunction after successful resuscitation from cardiac arrest. , 1996, Critical care medicine.

[61]  A. Kellermann,et al.  Impact of first-responder defibrillation in an urban emergency medical services system. , 1993, JAMA.

[62]  J. Ornato,et al.  Transesophageal echocardiography to assess mitral valve function and flow during cardiopulmonary resuscitation. , 1992, The American journal of cardiology.

[63]  M. Weil,et al.  Cardiopulmonary resuscitation by precordial compression but without mechanical ventilation. , 1994, American journal of respiratory and critical care medicine.

[64]  A. Schneider,et al.  In-Hospital Cardiopulmonary Resuscitation: A 30-Year Review , 1993, The Journal of the American Board of Family Medicine.

[65]  Charles G. Brown,et al.  The effect of norepinephrine versus epinephrine on myocardial hemodynamics during CPR. , 1989 .

[66]  J. Varon.  Practical guide to the care of the critically ill patient , 1994 .

[67]  R. Raker,et al.  Randomized clinical study of thiopental loading in comatose survivors of cardiac arrest: Brain Resuscitation clinical Trial I Study Group. N Eng J Med 314:397–403, (February), 1986 , 1987 .

[68]  J S Geddes,et al.  A mobile intensive-care unit in the management of myocardial infarction. , 1967, Lancet.

[69]  Melinda F. Davis,et al.  Bystander cardiopulmonary resuscitation : concerns about mouth-to-mouth contact , 1995 .

[70]  A. Hallstrom,et al.  OUT-OF-HOSPITAL CARDIAC ARREST: IMPROVED SURVIVAL WITH PARAMEDIC SERVICES , 1980, The Lancet.

[71]  C. Otto,et al.  THE NEED FOR VENTILATORY SUPPORT DURING BYSTANDER CPR , 1995, Annals of emergency medicine.

[72]  M. Chow,et al.  Epinephrine versus methoxamine in survival postventricular fibrillation and cardiopulmonary resuscitation in dogs , 1989, Critical care medicine.

[73]  B. Krumbach,et al.  Resuscitation from prolonged cardiac arrest with high-dose intravenous magnesium sulfate. , 1991, The Journal of emergency medicine.

[74]  H. Gruchow,et al.  Randomized study of epinephrine versus methoxamine in prehospital ventricular fibrillation. , 1989, Annals of emergency medicine.

[75]  L. Shenkman,et al.  Predicting outcome of inhospital cardiopulmonary resuscitation. , 1988, Critical care medicine.

[76]  J. Varon,et al.  Cardiopulmonary resuscitation. New and controversial techniques. , 1993, Postgraduate medicine.

[77]  A. Hallstrom,et al.  Automatic external defibrillation: evaluations of its role in the home and in emergency medical services. , 1984, Annals of emergency medicine.

[78]  Should bystanders perform mouth-to-mouth ventilation during resuscitation? , 1994, Chest.

[79]  G. Ewy,et al.  The effect of bicarbonate on resuscitation from cardiac arrest. , 1991, Annals of emergency medicine.

[80]  C. Miller,et al.  Use of end-tidal carbon dioxide to predict outcome in prehospital cardiac arrest. , 1995 .

[81]  T. V. Woerkom,et al.  DIFFERENCE IN NEUROTRANSMITTER METABOLISM IN FRONTOTEMPORAL-LOBE CONTUSION AND DIFFUSE CEREBRAL CONTUSION , 1977, The Lancet.

[82]  I. Sand.  Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis , 1990 .

[83]  A. Keren,et al.  Treatment of torsade de pointes with magnesium sulfate. , 1988, Circulation.

[84]  C. Barton,et al.  High-dose epinephrine improves the return of spontaneous circulation rates in human victims of cardiac arrest. , 1991, Annals of emergency medicine.

[85]  R. Califf,et al.  Randomised trial of magnesium in in-hospital cardiac arrest , 1997, The Lancet.

[86]  R. Hamlin,et al.  Effect of standard doses of epinephrine on myocardial oxygen delivery and utilization during cardiopulmonary resuscitation. , 1988, Critical care medicine.

[87]  J. Ornato,et al.  Attitudes of BCLS instructors about mouth-to-mouth resuscitation during the AIDS epidemic. , 1990, Annals of emergency medicine.

[88]  M. Heller,et al.  Open-chest cardiac massage. The possible rebirth of an old procedure. , 1990, Postgraduate medicine.

[89]  R. Winkle,et al.  Mortality in patients with implanted automatic defibrillators. , 1983, Annals of internal medicine.

[90]  C. Barton,et al.  Prediction of outcome of cardiopulmonary resuscitation from end‐tidal carbon dioxide concentration , 1990, Critical care medicine.

[91]  N. Madias,et al.  Assessing acid-base status in circulatory failure. Differences between arterial and central venous blood. , 1989, The New England journal of medicine.

[92]  J. Varon,et al.  Cardiopulmonary resuscitation: lessons from the past. , 1991, The Journal of emergency medicine.

[93]  P. Marik,et al.  An outcomes analysis of in-hospital cardiopulmonary resuscitation: the futility rationale for do not resuscitate orders. , 1997, Journal of critical care.

[94]  M. Gallagher,et al.  Emergent applications of cardiopulmonary support: a multiinstitutional experience. , 1992, The Annals of thoracic surgery.

[95]  Roger D. White,et al.  Prognostic value of end-tidal carbon dioxide pressures during out-of-hospital cardiac arrest. , 1995, Annals of emergency medicine.

[96]  R. Hamlin,et al.  Comparative effect of graded doses of epinephrine on regional brain blood flow during CPR in a swine model. , 1986, Annals of emergency medicine.

[97]  W. Pedersen,et al.  Intravenous amiodarone for the rapid treatment of life-threatening ventricular arrhythmias in critically ill patients with coronary artery disease. , 1989, The American journal of cardiology.

[98]  Cantab Ma,et al.  Emanuel Miller. M.A. Cantab., F.R.C.P., D.P.M. , 1970 .

[99]  J. Seward,et al.  The Mechanism of Blood Flow During Closed Chest Cardiac Massage in Humans: Transesophageal Echocardiography Observations , 1990 .

[100]  C. Miller,et al.  End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest. , 1997, The New England journal of medicine.

[101]  H. Werman,et al.  Adrenergic agonists during cardiopulmonary resuscitation. , 1990, Resuscitation.

[102]  M. Copass,et al.  Use of the automatic external defibrillator in the management of out-of-hospital cardiac arrest. , 1988, The New England journal of medicine.

[103]  P. Pepe,et al.  Regulating the Scope of EMS Services , 1990, Prehospital and Disaster Medicine.

[104]  A. Hallstrom,et al.  Sudden cardiac death in the community , 1984 .

[105]  V. Wenzel,et al.  The Composition of Gas Given by Mouth-to-Mouth Ventilation During CPR , 1994 .

[106]  A. Adgey,et al.  The accuracy of decision-making of a semi-automatic defibrillator during cardiac arrest. , 1992 .

[107]  M. Callaham,et al.  Active compression-decompression : a new method of cardiopulmonary resuscitation , 1992 .

[108]  A Hallstrom,et al.  Cardiac resuscitation in the community. Importance of rapid provision and implications for program planning. , 1979, JAMA.

[109]  M. Copass,et al.  Comparison of bretylium tosylate and lidocaine in management of out of hospital ventricular fibrillation: a randomized clinical trial. , 1981, The American journal of cardiology.

[110]  D. Chamberlain,et al.  Simple mechanical methods for cardioversion: defence of the precordial thump and cough version. , 1985, British medical journal.

[111]  J. Pearson,et al.  Evaluation of Drugs for Cardiac Resuscitation , 1963, Anesthesiology.

[112]  J. Allegra,et al.  Successful resuscitation and neurologic recovery from refractory ventricular fibrillation after magnesium sulfate administration. , 1992, Annals of emergency medicine.

[113]  D. Chamberlain,et al.  Automated external defibrillation: laboratory evaluation. , 1984, International journal of cardiology.

[114]  L. Bossaert,et al.  Guidelines for advanced life support , 1992 .

[115]  J. Darin,et al.  A randomized comparison study of bretylium tosylate and lidocaine in resuscitation of patients from out-of-hospital ventricular fibrillation in a paramedic system. , 1984, Annals of emergency medicine.

[116]  E. Harrison,et al.  Use of calcium in electromechanical dissociation. , 1984, Annals of emergency medicine.

[117]  M. DeBard.  The history of cardiopulmonary resuscitation. , 1980, Annals of emergency medicine.

[118]  M S Eisenberg,et al.  Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. , 1980, The New England journal of medicine.

[119]  J. Darin,et al.  Interposed abdominal compression CPR versus standard CPR in prehospital cardiopulmonary arrest: preliminary results. , 1984, Annals of emergency medicine.

[120]  R O Cummins,et al.  Lay person use of automatic external defibrillation. , 1987, Annals of emergency medicine.

[121]  T. J. Appleton,et al.  Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. , 1990, JAMA.

[122]  N. Abramson,et al.  Randomized clinical study of thiopental loading in comatose survivors of cardiac arrest. Brain resuscitation clinical trial I study group , 1986 .

[123]  P. Poole‐Wilson,et al.  Effect of pH on ionic exchange and function in rat and rabbit myocardium. , 1975, The American journal of physiology.

[124]  P. Paris,et al.  Effect of out-of-hospital defibrillation by basic life support providers on cardiac arrest mortality: a metaanalysis. , 1995, Annals of emergency medicine.

[125]  D. Angus,et al.  Cardiopulmonary resuscitation: what cost to cheat death? , 1996, Critical care medicine.

[126]  W. Grace,et al.  The mobile coronary care unit. , 1969, The Journal of the Medical Society of New Jersey.

[127]  Wanchun Tang,et al.  Cardiopulmonary resuscitation: a promise as yet largely unfulfilled. , 1997, Disease-a-month : DM.

[128]  M. Wayne,et al.  An automatic cardiac resuscitator for emergency treatment of cardiac arrest. , 1980, Medical instrumentation.

[129]  C W Otto,et al.  End-Tidal Carbon Dioxide Monitoring During Cardiopulmonary Resuscitation: A Prognostic Indicator for Survival , 1989 .

[130]  R. Mcgrath.  In-house cardiopulmonary resuscitation--after a quarter of a century. , 1987, Annals of emergency medicine.

[131]  J. Ornato,et al.  Early defibrillation: an advisory statement from the Advanced Life Support Working Group of the International Liaison Committee on Resuscitation. , 1997, Circulation.

[132]  B B Lerman,et al.  Relation between transcardiac and transthoracic current during defibrillation in humans. , 1990, Circulation research.

[133]  H. Levine,et al.  Distinctive time course of ventricular vulnerability to fibrillation during and after release of coronary ligation. , 1974, The American journal of cardiology.

[134]  L. Wiklund,et al.  Pathophysiologic and therapeutic implications of acid-base changes during CPR. , 1993, Annals of emergency medicine.

[135]  J. Varon,et al.  In-hospital resuscitation among the elderly: substantial survival to hospital discharge. , 1996, The American journal of emergency medicine.

[136]  R. Hamlin,et al.  Methoxamine versus epinephrine on regional cerebral blood flow during cardiopulmonary resuscitation , 1987, Critical care medicine.

[137]  T. Pringle,et al.  An external automatic device to detect ventricular fibrillation. , 1986, European heart journal.

[138]  B B Lerman,et al.  Current-based versus energy-based ventricular defibrillation: a prospective study. , 1988, Journal of the American College of Cardiology.

[139]  A. Keren,et al.  Suppression of ventricular arrhythmias by magnesium. , 1990, The American journal of cardiology.

[140]  E. Cook,et al.  Survival after Cardiopulmonary Resuscitation in the Hospital , 1983 .

[141]  H. Halperin,et al.  A preliminary study of cardiopulmonary resuscitation by circumferential compression of the chest with use of a pneumatic vest. , 1993, The New England journal of medicine.

[142]  M. Redmond,et al.  "Heartstart Scotland"--initial experience of a national scheme for out of hospital defibrillation. , 1991, BMJ.

[143]  A. Toyonaga,et al.  Effect of vasopressin on esophageal varices blood flow in patients with cirrhosis: comparisons with the effects on portal vein and superior mesenteric artery blood flow. , 1996, Journal of hepatology.

[144]  M. Weil,et al.  Cardiac output and end‐tidal carbon dioxide , 1985, Critical care medicine.

[145]  W. B. Kouwenhoven,et al.  Closed-chest cardiac massage. , 1960, JAMA.