TY - JOUR
T1 - Future directions for resuscitation research. III. External cardiopulmonary resuscitation advanced life support
AU - Ornato, Joseph P.
AU - Paradis, Norman
AU - Bircher, Nicholas
AU - Brown, Charles
AU - DeLooz, Herman
AU - Dick, Wolfgang
AU - Kaye, William
AU - Levine, Robert
AU - Martens, Paul
AU - Neumar, Robert
AU - Patel, Rita
AU - Pepe, Paul
AU - Ramanathan, Sivam
AU - Rubertsson, Sten
AU - Traystman, Richard
AU - Von Planta, Martin
AU - Vostrikov, Vyacheslav
AU - Weil, Max Harry
AU - Safar, Peter
PY - 1996/9
Y1 - 1996/9
N2 - This discussion about advanced cardiac life support (ACLS) reflects disappointment with the over 50% of out-of-hospital cardiopulmonary resuscitation (CPR) attempts that fail to achieve restoration of spontaneous circulation (ROSC). Hospital discharge rates are equally poor for in-hospital CPR attempts outside special care units. Early bystander CPR and early defibrillation (manual, semi-automatic or automatic) are the most effective methods for achieving ROSC from ventricular fibrillation (VF). Automated external defibrillation (AED), which is effective in the hands of first responders in the out-of-hospital setting, should also be used and evaluated in hospitals,inside and outside of special care units. The first countershock is most important. Biphasic waveforms seem to have advantages over monophasic ones. Tracheal intubation has obvious efficacy when the airway is threatened. Scientific documentation of specific types, doses, and timing of drug treatments (epinephrine, bicarbonate, lidocaine, bretylium) are weak. Clinical trials have failed so far to document anything statistically but a breakthrough effect. Interactions between catecholamines and buffers need further exploration. A major cause of unsuccessful attempts at ROSC is the underlying disease, which present ACLS guidelines do not consider adequately. Early thrombolysis and early coronary revascularization procedures should also be considered for selected victims of sudden cardiac death. Emergency cardiopulmonary bypass (CPB) could be a breakthrough measure, but cannot be initiated rapidly enough in the field due to technical limitations. Open-chest CPR by ambulance physicians deserves further trials. In searches for causes of VF, neurocardiology gives clues for new directions. Fibrillation and defibrillation thresholds are influenced by the peripheral sympathetic and parasympathetic nervous systems and impulses from the frontal cerebral cortex. CPR for cardiac arrest of the mother in advanced pregnancy requires modifications and outcome data. Until more recognizable critical factors for ROSC are identified, titrated sequencing of ACLS measures, based on physiologic rationale and sound judgement, rather than rigid standards, gives the best chance for achieving survival with good cerebral function.
AB - This discussion about advanced cardiac life support (ACLS) reflects disappointment with the over 50% of out-of-hospital cardiopulmonary resuscitation (CPR) attempts that fail to achieve restoration of spontaneous circulation (ROSC). Hospital discharge rates are equally poor for in-hospital CPR attempts outside special care units. Early bystander CPR and early defibrillation (manual, semi-automatic or automatic) are the most effective methods for achieving ROSC from ventricular fibrillation (VF). Automated external defibrillation (AED), which is effective in the hands of first responders in the out-of-hospital setting, should also be used and evaluated in hospitals,inside and outside of special care units. The first countershock is most important. Biphasic waveforms seem to have advantages over monophasic ones. Tracheal intubation has obvious efficacy when the airway is threatened. Scientific documentation of specific types, doses, and timing of drug treatments (epinephrine, bicarbonate, lidocaine, bretylium) are weak. Clinical trials have failed so far to document anything statistically but a breakthrough effect. Interactions between catecholamines and buffers need further exploration. A major cause of unsuccessful attempts at ROSC is the underlying disease, which present ACLS guidelines do not consider adequately. Early thrombolysis and early coronary revascularization procedures should also be considered for selected victims of sudden cardiac death. Emergency cardiopulmonary bypass (CPB) could be a breakthrough measure, but cannot be initiated rapidly enough in the field due to technical limitations. Open-chest CPR by ambulance physicians deserves further trials. In searches for causes of VF, neurocardiology gives clues for new directions. Fibrillation and defibrillation thresholds are influenced by the peripheral sympathetic and parasympathetic nervous systems and impulses from the frontal cerebral cortex. CPR for cardiac arrest of the mother in advanced pregnancy requires modifications and outcome data. Until more recognizable critical factors for ROSC are identified, titrated sequencing of ACLS measures, based on physiologic rationale and sound judgement, rather than rigid standards, gives the best chance for achieving survival with good cerebral function.
KW - Adrenergic agents
KW - Anti-arrhythmic agents
KW - Buffer agents
KW - Cardiac arrest
KW - Cardiopulmonary resuscitation
KW - Defibrillation
KW - Maternal resuscitation
KW - Neurocardiology
KW - Vagotonia
KW - Ventricular fibrillation
UR - http://www.scopus.com/inward/record.url?scp=0030248646&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0030248646&partnerID=8YFLogxK
U2 - 10.1016/0300-9572(96)00979-3
DO - 10.1016/0300-9572(96)00979-3
M3 - Article
C2 - 8896054
AN - SCOPUS:0030248646
SN - 0300-9572
VL - 32
SP - 139
EP - 158
JO - Resuscitation
JF - Resuscitation
IS - 2
ER -