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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2009 May;75(5):301-5
Revolving back to the basics in cardiopulmonary resuscitation
Roppolo L. P., Wigginton J. G., Pepe P. E.
1 Department of Surgery/Emergency Medicine, University of Texas Southwestern Medical Center at Dallas and the Parkland Health and Hospital System, Dallas, USA;
2 Department of Medicine, Surgery and Pediatrics and School of Public Health
University of Texas Southwestern Medical Center at Dallas and the Parkland Health and Hospital System, Dallas, USA;
3 City of Dallas Medical Emergency Services, Office of City Manager, Dallas, USA;
4 Dallas-Fort Worth Center for Resuscitation Medicine, Dallas, USA
Since the 1970s, most of the research and debate regarding interventions for cardiopulmonary arrest have focused on advanced life support (ALS) therapies and early defibrillation strategies. During the past decade, however, international guidelines for cardiopulmonary resuscitation (CPR) have not only emphasized the concept of uninterrupted chest compressions, but also improvements in the timing, rate and quality of those compressions. In essence, it has been a “revolution” in resuscitation medicine in terms of “coming full circle” to the 1960s when basic CPR was first developed. Recent data have indicated the need for minimally-interrupted chest compressions with an accompanying emphasis toward removing rescue ventilation altogether in sudden cardiac arrest, at least in the few minutes after a sudden unheralded collapse. In other studies, transient delays in defibrillation attempts and ALS interventions are even recommended so that basic CPR can be prioritized to first restore and maintain better coronary artery perfusion. New devices have now been developed to modify, in real-time, the performance of basic CPR, during both training and an actual resuscitative effort. Several new adjuncts have been created to augment chest compressions or enhance venous return and evolving technology may now be able to identify ventricular fibrillation (VF) without interrupting chest compressions. A renewed focus on widespread CPR training for the average person has also returned to center stage with ground-breaking training initiatives including validated video-based adult learning courses that can reliably teach and enable long term retention of basic CPR skills and automated external defibrillator (AED) use.