Few medical phenomena engage the popular and medical imaginations as
completely as resuscitation of the patient with out-of-hospital cardiac arrest.
Application of defibrillator paddles to the chest wall, administering an electrical
countershock, and restoring cardiac rhythm and circulation is depicted in
films and on television as a dramatic, often lifesaving event.
The medical reality, however, is that survival after out-of-hospital
cardiac arrest is uncommon. Despite decades of research and advances in resuscitation,
less than 5% of patients survive out-of-hospital cardiac arrest in the United
States.1,2 These outcomes have
prompted the suggestion that new approaches for treatment of cardiac arrest
due to ventricular fibrillation should be developed.3 In
this issue of THE JOURNAL, Wik and colleagues4 report
the results of a prospective, randomized comparison of manual cardiopulmonary
resuscitation (CPR) prior to defibrillation vs traditional immediate defibrillation
in patients with out-of-hospital cardiac arrest.
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