Cardiocerebral resuscitation: facts and prospects

Abstract

Cardiopulmonary resuscitation in the prehospital setting still has to cope with poor lay-rescuer knowledge of resuscitation techniques, low public availability of automated external defi brillators, many detrimental interruptions of chest compressions during lay and professional resuscitation eff orts and suboptimal postresuscitation care. Th erefore the survival of patients aft er cardiac arrest remains poor. To address those fl aws, cardiopulmonary resuscitation guidelines of 2005 are targeted at improving cardiopulmonary resuscitation by achieving adequate depth, number, and minimal interruptions of chest compressions per minute, and avoiding hyperventilation. But a combination of chest compressions and rescue breathing is still the mainstay of resuscitation ofi n primary and secondary cardiac arrest despite diff erent pathophysiological causes. In the last two decades a concept of cardiocerebral resuscitation emerged, and according to research it is equal to or even better than standard cardiopulmonary resuscitation in terms of patients\' prognosis aft er successful resuscitation of sudden or primary unexpected cardiac arrest. Cardiocerebral resuscitation of patients with primary cardiac arrest consists of layrescuer uninterrupted chest compressions without rescue breathing in the fi rst minutes of resuscitation, advanced life support techniques that do not interrupt chest compressions and thus maintain their positive hemodynamic eff ects. If professional rescuers arrive at the scene within 4 to 5 minutes aft er primary cardiac arrest, defi brillation should be attempted prior to resuscitation techiques, but if professional help arrives later than 4 to 5 minutes aft er primary cardiac arrest, two minutes of resuscitation techniques should be performed prior to the fi rst defi brillation. Post-resuscitation care includes mild induced hypothermia, coronarography and percutaneous coronary intervention.