Cardiocerebral and cardiopulmonary resuscitation – 2017 update

Abstract

Sudden cardiac arrest is a major public health problem in the industrialized nations of the world. Yet, in spite of recurrent updates of the guidelines for cardiopulmonary resuscitation and emergency cardiac care, many areas have suboptimal survival rates. Cardiocerebral resuscitation, a non‐guidelines approach to therapy of primary cardiac arrest based on our animal research, was instituted in Tucson (AZ, USA) in 2002 and subsequently adopted in other areas of the USA. Survival rates of patients with primary cardiac arrest and a shockable rhythm significantly improved wherever it was adopted. Cardiocerebral resuscitation has three components: the community, the pre‐hospital, and the hospital. The community component emphasizes bystander recognition and chest compression only resuscitation. Its pre‐hospital or emergency medical services component emphasizes: (i) urgent initiation of 200 uninterrupted chest compressions before and after each indicated single defibrillation shock, (ii) delayed endotracheal intubation in favor of passive delivery of oxygen by a non‐rebreather mask, (iii) early adrenaline administration. The hospital component was added later. The national and international guidelines for cardiopulmonary resuscitation and emergency medical services are still not optimal, for several reasons, including the fact that they continue to recommend the same approach for two entirely different etiologies of cardiac arrest: primary cardiac arrest, often caused by ventricular fibrillation, where the arterial blood oxygenation is little changed at the time of the arrest, and secondary cardiac arrest from severe respiratory insufficiency, where the arterial blood is severely desaturated at the time of cardiac arrest. These different etiologies need different approaches to therapy.

Knowledge, attitude, and perceived confidence in the management of medical emergencies in the dental office: A survey among the dental students and interns

“…As recommended by both Saudi Heart Association and American Heart Association, the single rescuer should begin CPR with 30 chest compressions followed by two breaths. [ 21 22 ] Although 66.7% of the participants knew the correct compression-ventilation ratio, a significant difference between the academic years has been recorded giving a higher prevalence among interns then followed by 3 rd , 5 th , and 4 th year.…”

Intraosseous versus intravenous vascular access during cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a systematic review and meta-analysis of observational studies

“…In a swine model, Zuercher et al [ 34 ] showed that early IO adrenaline administration was superior to delayed IV adrenaline injection in achieving 24-h survival. Therefore, despite that the meta-analytic results demonstrated inconclusive or non-significant association between either vascular access with OHCA outcomes, emergency care providers should still take into account the influence of delay in medication administration on outcomes when they attempt to establish vascular access, especially for patients with non-shockable rhythms [ 35 ]. It should especially be emphasized that no relevant clinical outcome-directed studies were identified in current review for pediatric patients, whose vascular access was difficult to be obtained during CPR.…”

Hands-On Times, Adherence to Recommendations and Variance in Execution among Three Different CPR Algorithms: A Prospective Randomized Single-Blind Simulator-Based Trial

“…No active ventilation takes place during the first three cycles [6][7][8][9]. Compared with the pre-implementation period CCR was associated with improved neurologically intact survival of patients with OHCA in large US regions [10].…”