Clinical Review

Cardiopulmonary resuscitation

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6122 (Published 03 October 2012) Cite this as: BMJ 2012;345:e6122
  1. Jerry P Nolan, consultant in anaesthesia and intensive care medicine1,
  2. Jasmeet Soar, consultant in anaesthesia and intensive care medicine2,
  3. Gavin D Perkins, professor of critical care medicine3
  1. 1Royal United Hospital NHS Trust, Bath BA1 3NG, UK
  2. 2Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  3. 3University of Warwick, Warwick Medical School, Warwick, UK
  1. Correspondence to: J P Nolan jerry.nolan{at}nhs.net

Summary points

  • About 8% of resuscitation attempts after out of hospital cardiac arrest result in survival to hospital discharge

  • Give chest compressions to a depth of 5-6 cm at 100-120 per minute; fully release between each compression and minimise interruptions; untrained bystanders should use compression only cardiopulmonary resuscitation (CPR)

  • CPR prompt and feedback devices improve the quality of CPR but have yet to be shown to improve survival

  • Undertake defibrillation with minimal interruption in chest compressions

  • The optimal method for managing the airway during cardiac arrest is unknown

  • Mechanical CPR devices may have a role during transport and in the cardiac catheterisation laboratory

  • Although adrenaline is recommended and used routinely, its effect on long term neurological outcome is unclear

Cardiorespiratory arrest is the most extreme medical emergency—death or permanent brain injury will ensue unless cardiopulmonary resuscitation (CPR) is started within minutes. Four key interventions—known collectively as the chain of survival and comprising early recognition of cardiac arrest, high quality CPR, prompt defibrillation, and effective post-resuscitation care—improve outcomes.w1 This review covers recent developments in CPR and the evidence supporting them.

Sources and selection criteria

The 2010 Consensus on Cardiopulmonary Resuscitation Science with Treatment recommendations published by the International Liaison Committee on Resuscitation summarised the findings from 277 systematic reviews based on PICO (population, intervention, comparison, outcome) format questions. We continuously screen the scientific literature for resuscitation studies and have supplemented our findings and the contents of the 2010 recommendations with PubMed searches to identify other relevant resuscitation studies published since 2010.

What is the incidence and outcome of sudden cardiac arrest?

The global incidence of out of hospital cardiac arrest in adults treated by emergency medical services is 62 cases per 100 000 person years; 75-85% of these arrests have a primary cardiac cause.1 The reported incidence of out of hospital cardiac arrest and its outcome vary considerably. In Europe, the estimated survival to hospital discharge …

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