Cardiopulmonary resuscitation. Historical and future perspectives

Although cardiopulmonary resuscitation (CPR) has been practiced for over a century, further study into methods for reviving victims of cardiac arrest is obviously needed. We now know that standard external CPR has numerous drawbacks, and modifications must be tested in a careful, randomized fashion. Three alternatives to standard external CPR (simultaneous compression-ventilation, interposed abdominal compression, and open-chest CPR) are currently being investigated. Of these procedures, open-chest CPR appears to show the most promise. Reproducible animal data must demonstrate the advantages of any method before widespread human studies are begun, however. If techniques seem promising in animals, well-controlled multicenter studies will be needed to verify applicability to humans. Major changes in CPR techniques should be made only after careful study, not on the basis of a limited number of reports from a single source. Resuscitation research must also extend beyond the study of techniques of cardiac massage. Although CPR is effective in some cases, clearly a person's chance of survival is directly linked to the speed of definitive care, that is, defibrillation. Research must continue into ways of providing rapid advanced cardiac care, such as home defibrillators or rapid prehospital response to the victims of cardiac arrest by those trained in advanced cardiac life support (ACLS). In addition, to counteract the problem of neurologic demise after prolonged anoxia, study of postresuscitative care must continue. Only through the combination of these measures will survival rates after cardiac arrest improve.