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 successful
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
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 successful
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
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