Doing the Same Thing Over and Over, yet Expecting Different Results
The fundamentals of modern day CPR, compressions and ventilations, were first described in the 1950s and 1960s. The American Heart Association endorsed CPR in 1963 followed by the first publication of the Advanced Cardiac Life Support Guidelines 1974. Since then, there have been modest changes in the delivery of CPR, primarily recommendations for compression/ventilation ratios, compression depth, advanced life support measures with early defibrillation, airway management and pharmacologic therapies and improved organization of emergency response systems. Despite these changes, survival from out-of-hospital cardiac arrest remains poor, usually < 10%. The usual scenario is institution of CPR by bystanders or emergency medical system (EMS) providers, advanced life support provided at the scene, then transport to the closest emergency department. If return of spontaneous circulation (ROSC) does not occur, the patient is declared at the scene or the process is repeated by hospital personnel until a pre-determined time interval has passed and the patient declared dead.
- Received August 30, 2013.
- Accepted September 4, 2013.