This Article Figures Only Full Text Full Text (PDF) View Related Cardiosource Journal Scan Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Ewy, G. A. Articles by Kern, K. B. Search for Related Content PubMed Articles by Ewy, G. A. Articles by Kern, K. B. Related Collections Related Article

STATE-OF-THE-ART PAPER

Recent Advances in Cardiopulmonary Resuscitation

Cardiocerebral Resuscitation

Gordon A. Ewy, MD, FACC^_*,_* and Karl B. Kern, MD, FACC

^_* University of Arizona Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona
Cardiac Catheterization Laboratories, University of Arizona College of Medicine, Tucson, Arizona

Manuscript received March 12, 2008; revised manuscript received May 22, 2008, accepted May 27, 2008.

^_* Reprint requests and correspondence: Dr. Gordon A. Ewy, University of Arizona Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona 85724 (Email: gaewy{at}aol.com).

Cardiocerebral resuscitation (CCR) is a new approach for resuscitation of patients with cardiac arrest. It is composed of 3 components: 1) continuous chest compressions for bystander resuscitation; 2) a new emergency medical services (EMS) algorithm; and 3) aggressive post-resuscitation care. The first 2 components of CCR were first instituted in 2003 in Tucson, Arizona; in 2004 in the Rock and Walworth counties of Wisconsin; and in 2005 in the Phoenix, Arizona, metropolitan area. The CCR method has been shown to dramatically improve survival in the subset of patients most likely to survive: those with witnessed arrest and shockable rhythm on arrival of EMS. The CCR method advocates continuous chest compressions without mouth-to-mouth ventilations for witnessed cardiac arrest. It advocates either prompt or delayed defibrillation, based on the 3-phase time-sensitive model of ventricular fibrillation (VF) articulated by Weisfeldt and Becker. For bystanders with access to automated external defibrillators and EMS personnel who arrive during the electrical phase (i.e., the first 4 or 5 min of VF arrest), the delivery of prompt defibrillator shock is recommended. However, EMS personnel most often arrive after the electrical phase—in the circulatory phase of VF arrest. During the circulatory phase of VF arrest, the fibrillating myocardium has used up much of its energy stores, and chest compressions that perfuse the heart are mandatory prior to and immediately after a defibrillator shock. Endotracheal intubation is delayed, excessive ventilations are avoided, and early-administration epinephrine is advocated.

Key Words: CPR • cardiocerebral • resuscitation • ventricular fibrillation

Abbreviations and Acronyms   ACLS = advanced cardiac life support   AED = automatic external defibrillator   CCC = continuous chest compression   CCR = cardiocerebral resuscitation   CPR = cardiopulmonary resuscitation   ECG = electrocardiograph   EMS = emergency medical services   OHCA = out-of-hospital cardiac arrest   PCI = percutaneous coronary intervention   PEA = pulseless electrical activity   STEMI = ST-segment elevation myocardial infarction   VF = ventricular fibrillation

Related Article

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2009 53: A24. [Full Text] [PDF]

This article has been cited by other articles:

				M. S. Seyal The Textbook of Emergency Cardiovascular Care and CPR JAMA, May 27, 2009; 301(20): 2163 - 2164. [Full Text] [PDF]

				D. P. Davis Cardiocerebral resuscitation: a broader perspective. J. Am. Coll. Cardiol., January 13, 2009; 53(2): 158 - 160. [Abstract] [Full Text] [PDF]