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(Circulation. 2003;107:794.)
© 2003 American Heart Association, Inc.

Cardiopulmonary Resuscitation

One Size Does Not Fit All

Max Harry Weil, MD, PhD; Wanchun Tang, MD; Joe Bisera, MSEE

From the Institute of Critical Care Medicine, Palm Springs, Calif.

Correspondence to Max Harry Weil, MD, PhD, The Institute of Critical Care Medicine, 1695 North Sunrise Way, Building #3, Palm Springs, CA 92262. E-mail weilm@911research.org

Key Words: Editorials • cardiopulmonary resuscitation • heart arrest • defibrillation • death, sudden

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The epidemic of "sudden death," primarily due to a dysrhythmic event that is triggered by ischemia of the myocardium, is the predominant mechanism of cardiac arrest in industrialized countries. The emphasis on early defibrillation and therefore on public access defibrillation is a response to this epidemic.^1–4 However, the emphasis on sudden death should not dominate discussion to the extent that other mechanisms of cardiac arrest are minimized. Stated simply, one size does not fit all. In an attempt to simplify interventions by bystanders, we have had to de-emphasize "diagnosis."

Especially in younger victims of cardiac arrest, including crib death and drowning, and in individuals of all ages who have airway obstruction after aspiration of particulates, after traumatic injuries, and as a neurological complication of strokes or drug overdoses, the primary cause is asphyxia. It is in this setting that the "golden seconds" would best be preserved for restoring gas exchange. However, literally minutes are currently wasted after application of automated defibrillators (AEDs) because they are used for repetitive rhythm analysis and capacitor charging.⁵

These adverse effects of AEDs prompted at least 2 modifications. The first idea, which is a concept for guiding the further development of the technology, is to define 2 discrete types of cardiac arrest. The non-professional rescuer would best be prompted to priorities of intervention contingent on this differentiation. We have suggested the terms dysrhythmic or primary cardiac arrest to contrast with asphyxial, respiratory, or secondary cardiac arrest for this purpose.⁶

The second modification is further development . . . [Full Text of this Article]

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