Recent advances: Cardiopulmonary resuscitation

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Abstract
Although cardiopulmonary resuscitation (CPR) has been practised for nearly 40 years, survival after cardiac arrest outside hospital remains low (table 1).2 3 4 5 6 7 8 Most events are associated with underlying coronary artery disease, but only a minority of patients will have an associated acute myocardial infarction.9 Holter monitor studies of patients who had a cardiac arrest outside hospital have found that most patients initially develop ventricular tachycardia before they progress to ventricular fibrillation. If untreated, cardiac rhythm deteriorates to asystole in several minutes.10 The most important predictors of survival after cardiac arrest are whether the arrest was witnessed, the time from collapse to defibrillation, and the initial cardiac rhythm identified by emergency staff. Patients with asystole rarely survive.5 11