Cardiocerebral resuscitation: a better approach to cardiac arrest.

PURPOSE OF REVIEW: To present a new approach to patients with cardiac arrest that improves neurologically normal survival. It is called cardiocerebral resuscitation (CCR), rather than cardiopulmonary resuscitation, as the major goal in cardiac arrest is to resuscitate the heart and the brain. CCR has three components: continuous chest compressions cardiopulmonary resuscitation for bystanders; a different Advanced Cardiac Life Support (ACLS) algorithm for Emergency Medical System; and a recently added aggressive postresuscitation care for resuscitated but comatose patients that includes therapeutic hypothermia and early catheterization/intervention.

RECENT FINDINGS: Kellum et al. instituted the first two components of CCR in rural Wisconsin in 2004. In the subgroup of patients with a witnessed cardiac arrest and a shockable rhythm they found that neurological intact survival at hospital discharge was 15% the preceding 3 years, when the 2000 Guidelines were being followed, but 40% for the 3 years during CCR. Bobrow et al. instituted CCR for out-of-hospital cardiac arrest in metropolitan areas of Arizona and found a greater than 300% improvement (4.7-17.6%) in survival to hospital discharge of this subgroup of patients.

SUMMARY: CCR improves survival of patients with cardiac arrest.