Chapter 1 Cardiopulmonary resuscitation
Cardiopulmonary resuscitation (CPR) is one of the most difficult areas in clinical medicine and outcomes are often said to be extremely poor, especially in patients with unwitnessed out-of-hospital cardiac arrest. While many accepted practices do not yet have a strong evidence base, a number of principles can now reasonably be supported. Any attempt at resuscitation is worthwhile and, although some recommendations have changed, it is acceptable and appropriate that staff or bystanders trained in using previous practices use their known skills.
Despite the difficulties in performing research in this area, the body of evidence is growing and new concepts such as circulatory support alone (chest compression without active ventilation), devices and techniques to provide more effective external chest compression, devices for minimally invasive internal cardiac massage and improved technology for electrical therapy (biphasic cardioversion) are under investigation. Recent work suggests controlled hypothermia may improve neurological outcome post-arrest in some patients. Broader public education, improved telecommunications and increased availability of defibrillators have also had considerable impact.