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Clinical Review

Recent advances: Cardiopulmonary resuscitation

BMJ 1997; 314 doi: (Published 17 May 1997) Cite this as: BMJ 1997;314:1462
  1. Kenneth A Ballew, assistant professora
  1. a Division of General Internal Medicine, University of Virginia, School of Medicine, 2955 Ivy Road, Suite 205, Charlottesville, VA 22908, USA


    Coronary artery disease is the leading cause of death in most developed countries. In the United States alone, 500 000 deaths a year are caused by coronary artery disease, over half of which are due to sudden cardiac arrest.1 Often cardiac arrest is the initial manifestation of coronary artery disease, so many of these patients if successfully resuscitated could have years of productive life remaining. Improvements in cardiopulmonary resuscitation therefore could have an appreciable impact on total mortality.

    Cardiac arrest outside hospital

    Although cardiopulmonary resuscitation (CPR) has been practised for nearly 40 years, survival after cardiac arrest outside hospital remains low (table 1).2 3 4 5 6 7 8 Most events are associated with underlying coronary artery disease, but only a minority of patients will have an associated acute myocardial infarction.9 Holter monitor studies of patients who had a cardiac arrest outside hospital have found that most patients initially develop ventricular tachycardia before they progress to ventricular fibrillation. If untreated, cardiac rhythm deteriorates to asystole in several minutes.10 The most important predictors of survival after cardiac arrest are whether the arrest was witnessed, the time from collapse to defibrillation, and the initial cardiac rhythm identified by emergency staff. Patients with asystole rarely survive.5 11

    View this table:
    Table 1

    Survival to discharge in studies of prehospital cardiopulmonary resuscitation (CPR) that included comparison of patients who received or did not receive cardiopulmonary resuscitation from bystanders

    Recent advances in cardiopulmonary resuscitation

    Sudden cardiac arrest remains a major cause of death in developing countries

    Despite years of experience with cardiopulmonary resuscitation, survival after cardiac arrest continues to be quite low

    Automatic external defibrillators and bystander cardiopulmonary resuscitation improve survival after sudden cardiac arrest

    Doctors should identify and counsel those patients who are not candidates for cardiopulmonary resuscitation

    Automatic external defibrillators

    Because two of the best predictors of survival of cardiac arrest are time to …

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