Cardiocerebral Resuscitation Improves Neurologically Intact Survival of Patients With Out-of-Hospital Cardiac Arrest

Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post–Cardiac Arrest in a Porcine Model

“…Improvements in our initial treatment of such individuals have resulted in an increasing number being successfully resuscitated and admitted to the hospital for further post cardiac arrest care (2)(3)(4)(5)(6)(7)(8). The vast majority are comatose upon arrival, making their long-term prognosis difficult to determine in the first few hours or days.…”

Out-of-Hospital Cardiac Arrest

“…42 Some have modified CCR by intubating earlier if the initial rhythm is not shockable. 43 Although much research is still underway regarding CCR, the early data is favorable. One study designed as a before-and-after intervention introducing CCR into an EMS system while all other factors remained constant reported that the rate of those who survived to discharge increased (47% vs 20%; P = not reported) and the total number of patients neurologically intact (39% vs 15%; P 5 not reported) increased.…”

Epinephrine in Resuscitation: Curse or Cure?

“…As noted previously, epinephrine may not be the ideal vasopressor to use during resuscitation of cardiac arrest, as it is the a-or vasoconstrictive effects of epinephrine that are beneficial, while its b-effects may be detrimental. Clinical experience with more effective approaches to resuscitation of OHCA has resulted in better survival [81], but also a higher incidence of recurrent VF during resuscitation efforts. This may be due to the excessive b-adrenergic effects of epinephrine.…”

“…It has now been shown in several clinical studies that CCR (a new ACLS approach that prohibits early endotracheal intubation, advocates 200 chest compressions before and immediately after a single shock and advocates the early administration of epinephrine) significantly improves survival of patients with OHCA who have a witnessed arrest and a shockable rhythm on arrival of the paramedics [81,84,86,87,93].…”

“…A cogent argument can be made that during the early minutes of resuscitation efforts, there are other interventions that have been shown to improve survival, such as the use of continuous chest compression CPR by bystanders [83], delaying or eliminating endotracheal intubation [81,[84][85][86][87][88], early and continuous chest compressions and early defibrillation [84,86,[89][90][91]. The requirement for the establishment of intravenous access and intra venous drug therapy (often with its resultant interruptions to chest compressions) is difficult to meet efficiently and may be counterproductive.…”