[Treatment strategies in mechanical and electrical cardiovascular failure]

Guidelines in cardiopulmonary resuscitation [CPR] improve survival of patients in cardiac arrest. Programs with both Basic Life Support [BLS], promptly initiated, and early defibrillation must be designed to motivate persons trained in prehospital CPR. The most frequent lethal rhythm in cardiac arrest is ventricular fibrillation [VF], affecting over 75% of patients. Early defibrillation must have the highest priority as the only method for termination of VF and being the major determinant for survival. Administration of 1.0 mg epinephrine iv as the drug of choice, followed by defibrillation [360 J] in patients with recurrent/persistent VF remains gold standard in Advanced Cardiac Life Support [ACLS]; epinephrine administered in the same, or higher, dosage can be repeated every 3-5 minutes followed by defibrillation within 30-60 seconds. Management of asystole and pulseless electrical activity is discussed, including the necessity to search for treatable causes as one major action, in addition to performing ACLS and administering epinephrine.