Recent Developments in the Treatment of Sudden Death Syndrome

Abstract

Several recent developments in cardiopulmonary resuscitation (CPR) appear to be headed toward clinical application in the foreseeable future. Studies have shown that much of the blood flow to the brain during CPR is caused by pressure changes in the thoracic cavity produced by chest compressions and, to some extent, by artificial ventilation. This newly described thoracic-pump mechanism and the traditional vascular-compression mechanism are both believed to be operational during CPR. Cardiac compression may, however, be superior to the thoracic-pump mechanism for producing coronary-artery blood flow. A new CPR technique, simultaneous ventilation and compression during CPR (SVC-CPR) has been demonstrated to improve carotid-artery flow predominantly by the thoracic-pump mechanism. Vigorous coughing during ventricular fibrillation (cough CPR) has been shown to produce blood flow. Limited studies demonstrate that a new airway, the pharyngeal tracheal lumen, designed for rapid insertion without extensive operator training, may be as effective as an endotracheal tube. New reports present evidence that the traditional practice of using precordial electrode placement for emergency defibrillation and chest-to-back electrode placement for cardioversion may not be necessary or even appropriate. Although further study and refinement of the implantable automatic defibrillator are necessary, it too holds promise as a lifesaving measure.