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(Circulation. 2007;116:2894-2896.)
© 2007 American Heart Association, Inc.

Editorial

Continuous-Chest-Compression Cardiopulmonary Resuscitation for Cardiac Arrest

Gordon A. Ewy, MD

From the University of Arizona College of Medicine, Sarver Heart Center, Tucson.

Correspondence to Gordon A. Ewy, MD, Professor and Chief of Cardiology, University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724. E-mail gaewy@aol.com

Key Words: Editorials • cardiopulmonary resuscitation • heart arrest

An extract of the first 250 words of the full text is provided, because this article has no abstract.

It is well known that out-of-hospital sudden cardiac death is a leading public health problem in the industrialized world. In the absence of early defibrillation, survival rates of patients with out-of-hospital cardiac arrest (OHCA) in most areas of the world are dismal and, except for a recent report of an improved rate of survival when their paramedic protocol was changed, have remained essentially unchanged.^1,2

Articles p 2900 and 2908

Why have survival rates not improved? One possibility is that the guidelines are not optimal. The guidelines advocate the same approach for 2 entirely different pathophysiological conditions: respiratory arrest in which severe arterial hypoxia and hypotension eventually lead to secondary cardiac arrest, and primary cardiac arrest in which the arterial blood is fully saturated with oxygen at the time of the arrest.¹ Mouth-to-mouth ventilations, although appropriate for respiratory arrest, are not, as will be reviewed, essential for survival in the vast majority of patients with OHCA. The recommendation for so-called rescue breathing is a major impediment to performing the crucial first link in the chain of survival.³ Only about a quarter of individuals with OHCA receive bystander resuscitation efforts before the arrival of emergency medical services personnel.⁴

Cardiopulmonary resuscitation (CPR) is traditionally defined as chest compressions plus ventilations. The need for chest compressions is unquestionable, but the need for or advisability of mouth-to-mouth ventilations for cardiac arrest has been questioned. Two articles in this issue of Circulation, one by Iwami and associates⁵ from Osaka, Japan, and the other by Bohm . . . [Full Text of this Article]

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