[New aspects of cardiopulmonary resuscitation]

Abstract

Objectives: To analyse the current knowledge based on the experimental and clinical research studies focused on cardiopulmonary resuscitation.

Data sources: International guidelines and recent review articles. Data collected from the Medline database with the keyword: cardiac arrest (CA).

Study selection: Research studies published during the last ten years were reviewed. Relevant clinical information was extracted and discussed.

Data synthesis: Last guidelines include significant modification in the management of cardiac arrest patient. Recognition of CA by lay rescuers is done on the absence of vital sign (no reactivity, no breathing) and it is now only recommended for healthcare providers to check the pulse. It is confirmed that chest compression has to prevail over ventilation and has to be done at a rate of 100 compressions per minutes with a compression-ventilation ratio of 30: 2. A short period of CPR before attempting defibrillation may be considered in adults with out-of-hospital ventricular fibrillation (VF) or pulseless ventricular tachycardia and a delay to EMS response. Defibrillation is provided with biphasic waveform at 150-200 J and is immediately followed by a 2 min period of CPR. Adrenaline remains the drug of choice in cardiac arrest whatever the first rhythm because no benefit has been demonstrated with vasopressin in term of survival. Amiodarone is the first line antiarrhythmic, improves short-term survival and is currently recommended after the second shock for resistant VF. Postresuscitation treatment is now receiving greater emphasis in emergency cardiovascular care, but there is little evidence to support specific therapies with the exception of hypothermia (12-24 h at 32-34 degrees C) that is currently recommended if patient remains unconscious after VF. Revascularization should also be discussed if CA is presumed to be from ischemic origin.

Conclusion: The last international 2005 guidelines include significant modifications of CPR. However, many questions remain unresolved and controlled studies are still needed before other changes could be recommended for routine practice. Our greatest challenge and highest priority is the training of lay rescuers and healthcare providers in simple, high-quality CPR skills that can be easily taught, remembered, and implemented to save lives.