Recent Advances in Cardiopulmonary Resuscitation

Abstract

Continuing research in cardiopulmonary resuscitation (CPR) probably will cause changes in methods and standards. In addition to the concept that CPR blood flow is caused by compression of the heart, it now appears that increased intrathoracic pressure produced by thoracic compression or by cough may improve arterial flow to peripheral tissues. Thus, high ventilation pressure during CPR may increase rather than decrease cardiac output. Simultaneous chest compression and ventilation appear to increase cerebral blood flow. Recent evidence stresses that chest compression should occupy at least 50 per cent of cycle time, and adequate depth of chest compression is also very important. Manual compressors probably will be used more because they do not fatigue. A radical new technique to generate artificial circulation is cough-CPR; it may be valuable to have conscious victims of cardiac arrest cough vigorously about once a second to create circulation until defibrillation can be carried out. Intrapulmonary instillation of epinephrine is also being studied. If an endotracheal tube is placed before an intravenous line has been established, epinephrine can be blown through the tube and into the smaller airways by positive pressure. Some researchers are studying the use of barbiturates to reduce brain oxygen requirements after resuscitation. Respiratory care practitioners should keep informed about new developments and possible new CPR standards in the coming decade.