In addition to overall survival rates, recent statistics on neurological recovery after resuscitation are also disappointing when put into historical perspective. Dr Stephenson's 1953 article reported that 56% of the 1200 resuscitations were suc¬cessful in restarting the heart, and only 8 of these patients were rendered decerebrate.74 The first successful human defibrillation, in 1947, involved cardiac massage for over an hour, and yet the patient had no long-term neurological deficits.46 These data contrast with the current experience, in which brain damage is a frequent cause of death after cardiac arrest.75 The impact of cerebral anoxic damage today may even be underreported because resuscitation efforts may be terminated solely because of elapsed time before return of spontaneous circulation is achieved, amid concern for neurological sequelae if the heart is eventually restarted. Because intracranial catastrophes are rarely the cause of cardiac arrest, neurological injury after resuscitation from a witnessed arrest almost universally signifies a failure to provide sufficient cerebral oxygen flow during CPR efforts. It is therefore with the dual goal of achieving cardiopulmonary and neurological recovery that novel CPR techniques are being investigated and resuscitation guidelines are being revised to optimize the basic steps of life support: airway, breathing, circulation, and defibrillation. The American Heart Association guidelines were most recently revised in 2005, with recommendations being strongly driven by evidence-based medicine.76