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(Circulation. 2005;111:2134-2142.)
© 2005 American Heart Association, Inc.

Special Report

Cardiocerebral Resuscitation

The New Cardiopulmonary Resuscitation

Gordon A. Ewy, MD

From the University of Arizona Sarver Heart Center, University of Arizona, Tucson, Ariz.

Correspondence to Gordon A. Ewy, MD, Professor and Chief, Cardiology, Director, University of Arizona Sarver Heart Center, University of Arizona, Tucson, AZ 85724. E-mail gaewy@aol.com

Received August 4, 2004; revision received November 24, 2004; accepted December 10, 2004.

Key Words: cardiopulmonary resuscitation • defibrillation • fibrillation • perfusion • cardiac arrest

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

	Introduction

 

"Why is it that every time I press on his chest he opens his eyes, and every time I stop to breathe for him he goes back to sleep?"¹

This article reviews research that shows that cardiopulmonary resuscitation (CPR) as it has been practiced and as it is presently taught and advocated is far from optimal. The International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, hereafter referred to as "Guidelines 2000," were evidence based.² During their formulation, the greatest weight of evidence was given to placebo-controlled randomized trials in humans. Unfortunately, it is extremely difficult not only to obtain informed consent but also to obtain funding for studies of the magnitude necessary to answer critically important CPR questions. It is unfortunate that controlled CPR research in animals was given the lowest priority in the evidence-based scheme.² In our opinion, controlled animal experiments provide data that may be nearly impossible to obtain in human trials in which the circumstance, age, disease states, interventions, and response times to arrest are variable and often unknown. On the other hand, the use of swine for CPR research is not the perfect experimental solution, because they are easier to resuscitate in that they have no underlying heart disease (unless experimentally produced), they are younger, and they have more compliant chests than older adults with cardiac arrest.

Since the formulation of "Guidelines 2000," old and new research in animals and new research in humans have rendered them outdated. Although they will be revised, . . . [Full Text of this Article]

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