Organization of resuscitation within the hospital

Current standards for resuscitation in the hospital include special care areas, a mobile resuscitation team, and training of all nurses and physicians in basic life support. The yield is the saving of a substantial number of lives. The expenditure is patient suffering and hospital costs in cases of initial revival and subsequent death after maximal therapy, infliction of thoracic skeletal lesions necessitating prolonged ventilator support, and survival with brain damage. Concern also exists for death from unattended cardiac arrest in a nonmonitored hospital bed or at home after the patient's discharge from the emergency department as a result of the physician's underestimation of the gravity of the symptoms. Recommendations focus on the improvement of information to the primary decision maker, often the inexperienced young house physician; a more comprehensive understanding of the nature of cardiac arrest; contraindications for resuscitation such as terminal illness or low quality of life; and the role of early application of DC countershock. The time is past when the organization of resuscitation in the hospital can be limited to the mechanics of training in artificial ventilation and cardiac massage.