Recent advances in cardiopulmonary-cerebral resuscitation: a review

Standard external CPR (SECPR) steps A, B, and C can maintain the brain's viability if started immediately, but not after prolonged arrest times. "New CPR" (simultaneous ventilation-compression CPR, SVC-CPR) is not suitable for basic life support, and may not be physiologically superior to optimally performed SECPR. The superiority of interposed abdominal compression CPR (IAC-CPR) over SECPR for basic life support is also uncertain. Open-chest CPR is physiologically superior to all external CPR methods studied thus far. Open-chest CPR should again be taught to physicians, and used more often after prolonged cardiac arrest. In intractable cases of cardiac arrest, particularly after prolonged arrest times or cold water drowning, cardiopulmonary bypass appears promising. After restoration of normal perfusion pressures and blood gases, a brain-oriented intensive care protocol for the support of extracerebral organs leads to better outcome than "usual care." Reflow promoting measures, particularly intracarotid hypertensive hemodilution, ameliorate postarrest brain damage and should be developed for clinical use. Barbiturates have been shown to exert no breakthrough effect on outcome after cardiac arrest, but are safe in the hands of those skilled in advanced intensive care. Barbiturates may be of adjunctive value after prolonged cardiac arrest, particularly when used to suppress seizures, facilitate controlled ventilation, and reduce intracranial pressure. Calcium entry blockers have been shown in animal models to improve hemodynamics and cerebral outcome postarrest, but not consistently.(ABSTRACT TRUNCATED AT 250 WORDS)