Recommendations for Cardiopulmonary Cerebral Resuscitation

Abstract

Irreversible brain damage may occur when cessation of circulation (cardiac arrest) lasts longer than a few minutes. Resuscitative measures, however, can be initiated anywhere without use of equipment, by trained individuals, ranging from the lay public to the physician specialist. The history of modern cardiopulmonary resuscitation (CPR) includes the following steps during the past 30 years:1. Proof that ventilation with the operator's exhaled air is physiologically sound and superior to manual chestpressure arm-lift maneuvers (Elam, Safar, Gordon).2. Re-discovery and development of external cardiac compression (Kouwenhoven).3. Demonstration of the need to combine positive pressure ventilation with external cardiac compression (Safar).4. Intrathoracic and external electric defibrillation of the heart (Prevost, Zoll, Beck).For didactic purposes, Safar has divided cardiopulmonary - cerebral resuscitation (CPCR) into three phases and nine steps, using the letters of the alphabet from A to I.Basic Life Support is for emergency tissue oxygenation and consists of: A) airway control; B) breathing support, artificial ventilation of the lungs; and C) circulation support, recognition of pulselessness and establishment of an artificial circulation by cardiac compressions.Advanced Life Support addresses restarting spontaneous circulation and stabilizing the cardiopulmonary system. Phase II consists of steps: D) drugs and fluids by intravenous infusion; E) electrocardiography; and F) fibrillation treatment by electric countershock.Prolonged Life Support represents brainoriented intensive care for multiple organ failure in the post-resuscitative period. Phase III should be continued until the patient regains consciousness, brain death has been certified, or his underlying disease makes further resuscitation efforts useless.