A non-guidelines approach to cardiocerebral resuscitation

Abstract

Cardiovascular disease is a leading cause of death in most Western industrialized nations, making out-of-hospital cardiac arrest (OHCA) a major public health problem (Atwood et al, 2005; Lloyd-Jones, 2010). Unfortunately, the first sign of cardiovascular disease is often the last, as the first sign is often sudden cardiac arrest (Roger et al, 2011). It is not just a problem of the elderly as the average decade of adults with OHCA is the sixth (Bobrow et al, 2010). In the US, a 40 year-old-male has a 1 in 8 chance of dying from cardiac arrest (Lloyd-Jones, 2010). This article will present a non-guidelines approach to the management of patients with primary OHCA that significantly improves survival. It is called ‘cardiocerebral resuscitation’ as it limits interruptions of blood flow to the heart and the brain by emphasizing near continuous chest compressions not only by bystanders but also by advanced life support (ALS) providers. It deemphasizes assisted ventilation, as patients with primary cardiac arrest have nearly normal arterial blood oxygenation at the onset of their arrest. We present the details of cardiocerebral resuscitation and the published studies that have documented improved survival of patients with OHCA so treated. It emphasized that guideline cardiopulmonary resuscitation (CPR) and ALS should be reserved for patients with secondary cardiac arrest; secondary to drowning, drug overdose and other forms cardiac arrest that are secondary to respiratory failure.