Artificial perfusion techniques during cardiac arrest: questions of experimental focus versus clinical need

Contemporary cerebral-cardiopulmonary resuscitation investigations in the experimental laboratory have defined mechanisms for blood flow during closed-chest CPR and have demonstrated that the current CPR technique produces limited systemic perfusion. Modified closed-chest CPR techniques usually improve perfusion. Unfortunately few laboratory CPR studies have actually investigated resuscitation and survival. In addition, the animal model employed (prolonged ventricular fibrillation) may have limited clinical relevance, based on clinical experience and resuscitation practice, and data reporting techniques and their interpretation may be affected by control values that are not normal because of the effects of anesthetics. Closed-chest CPR was intended to buy time until a countershock could be delivered. Clinical and laboratory experience indicate that this goal can be met. Cerebral perfusion during closed-chest CPR is low, but adequacy from a functional perspective following restoration of circulation has not been carefully studied. Preservation of neuronal integrity after restoration of spontaneous circulation may be more important than cerebral perfusion during cardiac arrest and CPR. The role and benefit of open-chest CPR have yet to be determined, because this technique will most likely be used after conventional CPR failure. New and different experimental models are required to meet clinical needs and challenges. The alliance between practitioner and investigator should be strengthened if common goals are to be attained.