CPR and postarrest care: overview, documentation, and databases

It is estimated that 350,000 people suffer a cardiac arrest each year in the United States, with one-half occurring out-of-hospital and the other half in-hospital. Overall survival is < 10% and has not changed significantly for decades. CPR is the umbrella term for attempts to restore organized cardiac contractility and functional blood flow. Physicians have studied resuscitation techniques for millennia. In 1964, Peter Safar published the first ABCs of Heart-Lung Resuscitation, which included: (1) first aid, (2) start spontaneous circulation, and (3) support recovery. Many of these principles were incorporated into the first official CPR guidelines developed by the American Heart Association in 1966. These guidelines have been updated periodically since then, with the most recent iteration developed in November 2010. Fundamental principles, such as early defibrillation, chest compressions performed at the appropriate rate and depth, and delivery of postarrest care, are affirmed in the recent guidelines update. In addition, a greater emphasis has been placed on quality of CPR, with the need to minimize interruptions, the reordering of CPR priorities to place chest compressions before ventilations, and the need for comprehensive postarrest care that includes both targeted temperature and hemodynamic management. Whether a cardiac arrest occurs out-of-hospital or in-hospital, the basic approach to CPR and postarrest care is identical. Documentation should be performed in a standardized fashion, using a consensus set of data elements known as the Utstein format, and can contribute to quality improvement, research, and billing efforts.