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August 1, 1980, Vol 244, No. 5 >
ARTICLE | August 1, 1980

Standards and Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) FREE

[+] Author Affiliations

These standards and guidelines reflect the consensus of the 1979 National Conference that updated the supplement to JAMA, Feb 18, 1974, volume 227, No. 7, cosponsored by the American Heart Association and the National Academy of Sciences—National Research Council. The conference did not recommend major changes but has redefined some terms and expanded some of the procedures.

Reprints of Standards for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) are available from the American Heart Association, Distribution Department, 2005 Hightower Dr, Garland, TX 75041.


JAMA. 1980;244(5):453-509. doi:10.1001/jama.1980.03310050017015
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References

The National Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) held in September 1979 developed standards and guidelines for CPR and ECC. They encompass (1) principles and techniques for the performance of basic and advanced cardiac life support; (2) standards for training and certification in basic life support as defined by the American Heart Association; (3) recommendations for training, testing, and supervision of medical and allied health personnel; (4) the proposed role of the American Red Cross and other agencies in the training of the lay public; (5) a renewed, strong emphasis on community acceptance of responsibility for coronary heart disease morbidity and mortality and acceptance of organized implementation of primary and secondary prevention programs in parallel with ECC efforts; (6) definition of the role of ECC units in stratified systems of emergency care; and (7) medicolegal aspects of CPR and ECC.

(JAMA 244:453-509, 1980)

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James TN:  The coronary circulation and conduction system in acute myocardial infarction . Prog Cardiovasc Dis 10:410-449, 1968;.
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Gregory JJ, Grace WJ:  The management of sinus bradycardia, nodal rhythm and heart block for the prevention of cardiac arrest in acute myocardial infarction . Prog Cardiovasc Dis 10:505-517, 1968;.
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Forrester JS, Diamond G, Chatterjee K, et al:  Medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts) . N Engl J Med 295:1356-1362, 1976;.
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Cranefield PF:  Ventricular fibrillation . N Engl J Med 289:732, 1973;.
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Wiggers CJ, Wegria R:  Ventricular fibrillation due to single localized induction and condenser shocks applied during the vulnerable phase of ventricular systole . Am J Physiol 128:500-505, 1940;.
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Zipes DP, Fisher J, King RM, et al:  Termination of ventricular fibrillation in dogs by depolarizing a critical amount of myocardium . Am J Cardiol 36:37-44, 1975;.
187 +
Friedman PL, Stewart JR, Wit AL:  Spontaneous and induced cardiac arrhythmias in subendocardial Purkinje fibers surviving extensive myocardial infarction in dogs . Circ Res 33:612-626, 1973;.
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Geddes LA, Tacker WA, Rosborough JP, et al:  Electrical dose for ventricular defibrillation of large and small animals using precordial electrodes . J Clin Invest 53:310, 1974;.
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Collins RE, Giuliani ER, Tacker WA, et al:  Transthoracic ventricular defibrillation: Success and body weight . Med Instrumentation 12:53, 1978;.
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Gold JH, Schuder JC, Stoeckle H, et al:  Transthoracic ventricular defibrillation in the 100 kg calf with unidirectional rectangular pulses . Circulation 56:745-750, 1977;.
191 +
Tacker WA Jr, Galioto FM Jr, Guiliani E, et al:  Energy dosage for human transchest electrical ventricular defibrillation . N Engl J Med 290:214-215, 1974;.
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Pantridge JF, Adgey AAJ, Webb SW, et al:  Electrical requirements for ventricular defibrillation . Br Med J 2:313, 1975;.
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Pantridge JF, Adgey AAJ, Geddes JS, et al: The Acute Coronary Attack . New York, Grune & Stratton Inc, 1975;, p 71.
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Campbell NPS, Webb SW, Adgey AAJ, et al:  Transthoracic ventricular defibrillation in adults . Br Med J 2:1379, 1977;.
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Anderson GJ, Suelzer J:  The efficacy of trapezoidal wave forms for ventricular defibrillation . Chest 70:298, 1976;.
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Gascho JA, Crampton RS, Cherwek ML, et al:  Determinants of ventricular defibrillation in adults . Circulation 60:231-240, 1979;.
197 +
Tacker WA Jr, Ewy GA:  Emergency defibrillation dose: Recommendations and rationale . Circulation 60:223-225, 1979;.
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Kerber RE, Garnat W:  Factors influencing the success of ventricular defibrillation in man . Circulation 60:226-230, 1979;.
199 +
James TN:  The coronary circulation and conduction system in acute myocardial infarction . Prog Cardiovasc Dis 10:410-499, 1968;.
200 +
Varat MA, Mercer DW:  Cardiac specific creatine phosphokinase isoenzyme in the diagnosis of acute myocardial infarction . Circulation 51:855-859, 1975;.
201 +
Vasudevan G, Mercer DW, Varat MA:  Lactic dehydrogenase isoenzyme determination in the diagnosis of acute myocardial infarction . Circulation 57:1055-1057, 1978;.
202 +
Gallagher RJ, Civetta JM, Kirby RB:  Terminology update: Optimal PEEP . Crit Care Med 6:323-326, 1978;.
203 +
Forrester JS, Diamond G, Chatterjee K, et al:  Medical therapy of acute myocardial infarction by application of hemodynamic subsets . N Engl J Med 295:1356-1362, 1404-1413, 1976;.
204 +
Miller TR, Anderson RJ, Linas SL, et al:  Urinary diagnostic indices in acute renal failure: A prospective study . Ann Intern Med 89:47-50, 1978;.
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Abel RM, Beck CH Jr, Abbott WM, et al:  Improved survival from acute renal failure after treatment with intravenous essential L-amino acids and glucose . N Engl J Med 288:695-699, 1973;.
206 +
Nemoto EM:  Pathogenesis of cerebral ischemia-anoxia . Crit Care Med 6:203-214, 1978;.
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Safar P, Bleyaert A, Nemoto EM, et al:  Resuscitation after global brain ischemia-anoxia . Crit Care Med 6:215-227, 1978;.
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Mattar JC, Weil MH, Shubin H:  A study of the hyperosmolal state in critically ill patients . Crit Care Med 1:293-301, 1973;.
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Gregory GA:  Resuscitation of the newborn . Anesthesiology 43:225, 1975;.
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Dawes GS:  Birth asphyxia, resuscitation and brain damage , in Foetal & Neonatal Physiology . Chicago, Year Book Medical Publishers, 1968;, p 141.
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Scopes JW, Ahmed I:  Range of critical temperatures in sick and premature babies . Arch Dis Child 41:417, 1966;.
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Adamsons K, Gandy GM, James LS:  The influence of thermal factors upon oxygen consumption of the newborn human infant . J Pediatrics 66:495, 1965;.
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Codero L, Hon EH:  Neonatal bradycardia following nasopharyngeal suction . J Pediatrics 78:441, 1971;.
214 +
Gregory JA, Gooding CA, Phibbs RH, et al:  Meconium aspiration in infants—a prospective study . J Pediatrics 85:848, 1974;.
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Ting P, Brady JP:  Tracheal suction in meconium aspiration . Am J Obstet Gynecol 122:767, 1975;.
216 +
Carson BS, Losey RW, Bowes WA Jr, et al:  Combined obstetric and pediatric approach to prevent meconium aspiration syndrome . Am J Obstet Gynecol 126:712, 1976;.
217 +
Todres DI, Rodgers MC:  Methods of external cardiac massage in the newborn infant . J Pediatrics 86:781, 1975;.
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Carveth SW:  Eight-year experience with a stadium-based mobile coronary care unit . Heart Lung 3:770-774, 1974;.
221 +
Nolte CT, Grace WJ:  Life support units . Heart Lung 3:779, 1974;.
222 +
Eisenberg MS, Bergner L, Hallstrom A:  Cardiac resuscitation in the community: Importance of rapid provision and implications for program planning . JAMA 241:1905-1907, 1979;.
223 +
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225 +
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Black PM:  From heart to brain: The new definition of death . Am Heart J 99:279-281, 1980;.
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Rabkin MT, Gillerman G, Rice NR:  Orders not to resuscitate . N Engl J Med 295:364-366, 1976;.
231 +
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232 +
In re Quinlan, 70 NJ 10, 355A 2d 647, 1976.
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Superintendent of the Belchertown School vs Saikewicz, 370 NE 2d 417, 433 (Mass 1977).
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Relman A:  The Saikewicz decision: Judges as physicians . N Engl J Med 298:508, 1978;.
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Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
 Standards for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) . JAMA 227( (suppl) ):833-868, 1974;.
2 +
Kouwenhoven WB, Jude JR, Knickerbocker GG:  Closed-chest cardiac massage . JAMA 173:1064-1067, 1960;.
3 +
 Cardiopulmonary resuscitation: Statement by the Ad Hoc Committee on Cardiopulmonary Resuscitation of the Division of Medical Sciences, National Academy of Sciences—National Research Council . JAMA 198:372-379, 1966;.
4 +
Cardiopulmonary Resuscitation: Conference Proceedings, May 23, 1966 . Washington, DC, National Academy of Sciences, National Research Council, 1967;.
5 +
Emergency Resuscitation Team Manual: A Hospital Plan . New York, AHA, 1968;.
6 +
Emergency Measures in Cardiopulmonary Resuscitation . New York, AHA, 1971;.
7 +
Definitive Therapy in Cardiopulmonary Resuscitation . New York, AHA, 1971;.
8 +
Cardiopulmonary Resuscitation: A Manual for Instructors . New York, AHA, 1971;.
9 +
Training of Ambulance Personnel in Cardiopulmonary Resuscitation . New York, AHA, 1965;.
10 +
The Dentist's Role in Cardiopulmonary Resuscitation . New York, AHA, 1968;.
11 +
Training of Lifeguards in Cardiopulmonary Resuscitation . New York, AHA, 1970;.
12 +
Accidental Death and Disability: The Neglected Disease of Modern Society . Committee on Trauma and Committee on Shock, Division of Medical Sciences. Washington, DC, National Academy of Sciences, National Research Council, 1966;.
13 +
Medical Requirements for Ambulance Design and Equipment , bulletin 8774. Committee on Emergency Medical Services, Division of Medical Sciences. Washington, DC, National Academy of Sciences, National Research Council, 1970;.
14 +
Ambulance Design Criteria , bulletin 6032. Committee on Ambulance Design Criteria of the Highway Research Board, Division of Engineering. Washington, DC, National Academy of Sciences, National Research Council, (June) 1969;.
15 +
Training of Ambulance Personnel and Others Responsible for Emergency Care of the Sick and Injured at the Scene and During Transport , bulletin 8775. Committee on Emergency Medical Services, Division of Medical Sciences. Washington, DC, National Academy of Sciences, National Research Council, 1970;.
16 +
Refresher Training Program for Emergency Medical Technician-Ambulance , course guide, bulletin 9984. Washington, DC, US Dept of Transportation, National Highway Traffic Safety Administration, 1971;.
17 +
Roles and Resources of Federal Agencies in Support of Comprehensive Emergency Medical Services , bulletin 25269. Washington, DC, US Dept of Health, Education, and Welfare, National Academy of Sciences, National Research Council, 1972;.
18 +
Wright IS, Fredrickson DT:  Cardiovascular disease-acute care: Introduction: Inter-relationship among health facilities: Future role of modern communication and transportation; electronic equipment in critical care areas: Status of devices currently in use; resources for the optimal acute care of patients with congenital heart disease, report of Inter-Society Commission for Heart Disease Resources , abstracted. Circulation 43:97-99, 101-133, 1971;.
19 +
 Cardiovascular disease-acute care: Resources for the management of emergencies in hypertension, report of Inter-Society Commission for Heart Disease Resources , abstracted. Circulation 43:157-160, 1971;.
20 +
 Cardiovascular disease-acute care: Resources for the acute care of peripheral vascular diseases, report of Inter-Society Commission for Heart Disease Resources , abstracted. Circulation 43:161-169, 1971;.
21 +
 Cardiovascular disease-acute care: Resources for the optimal care of patients with acute myocardial infarction, report of Inter-Society Commission for Heart Disease Resources , abstracted. Circulation 43:171-183, 1971;.
22 +
 Cardiovascular disease-acute care: Resources for the optimal care of acute respiratory failure, report of Inter-Society Commission for Heart Disease Resources , abstracted. Circulation 43:185-195, 1971;.
23 +
 Cardiovascular disease-electronic equipment in critical care areas: Part II: The electrical environment report by the Instrumentation Study Group of the Inter-Society for Heart Disease Resources , abstracted. Circulation 44:237-246, 1971;.
24 +
 Critical performance criteria-defibrillators, report by the Instrumentation Study Group of the Inter-Society Commission for Heart Disease Resources , abstracted. Circulation 47:359-361, 1973;.
25 +
Basic Training Program for Emergency Medical Technician-Ambulance: Concepts and Recommendations , bulletin 7802. US Dept of Transportation, National Highway Safety Bureau, 1970;.
26 +
Basic Training Program for Emergency Medical Technician-Ambulance: Instructor's Lesson Plans , bulletin 14958. US Dept of Transportation, National Highway Safety Bureau, 1970;.
27 +
Communications-Guidelines for Emergency Medical Services . US Dept of Transportation, National Highway Traffic Safety Administration, 1972;.
28 +
Emergency Medical Services Communications Systems , bulletin 20369. US Dept of Health, Education, and Welfare, Health Services and Mental Health Administration, 1972;.
29 +
Compendium of State Statutes on the Regulation of Ambulance Services, Operation of Emergency Vehicles, and Good Samaritan Laws , bulletin 13341. Health Services and Mental Health Administration, Division of Emergency Health Services, 1969;.
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Emergency Health Services Selected Bibliography . Health Services and Mental Health Administration, Division of Emergency Health Services, 1970;.
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Emergency Care and Transportation of the Sick and Injured , ed 2, revised, American Academy of Orthopedic Surgeons, Committee on Allied Health. Chicago, AAOS, 1971;.
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Developing Emergency Medical Services: Guidelines for Community Councils , American Medical Association, Commission of Emergency Medical Services. Chicago, AMA, 1973;.
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Safar P: Cardiopulmonary Resuscitation: A Manual for Physicians and Paramedical Instructors . Pittsburgh, World Federation Society of Anesthesiologists, 1968;.
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Yu PN:  Prehospital care of acute myocardial infarction . Circulation 45:189-204, 1972;.
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CPR Lifesaving Techniques . Gallup Poll, Princeton, NJ, (June) 1977;.
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Proceedings of the First National Conference on the Medicolegal Implications of Emergency Medical Care . Dallas, AHA, 1976;.
46 +
Report on Emergency Airway Management . Committee on Emergency Medical Services, Assembly of Life Sciences, National Research Council, National Academy of Sciences, 1976;.
47 +
Eisenberg MS, Bergner L, Hallstrom A:  Cardiac resuscitation in the community: Importance of rapid provision and implications for program planning . JAMA 241:1905-1907, 1979;.
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Lund I, Skulberg A:  Cardiopulmonary resuscitation by lay people . Lancet 2:702-704, 1976;.
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Thompson RG, Hallstrom AP, Cobb LA:  Bystander-initiated cardiopulmonary resuscitation in the management of ventricular fibrillation . Ann Intern Med 90:737-740, 1979;.
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Heart Facts . Dallas, AHA, 1980;, p 24.
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Gordon T, Kannel WB:  Premature mortality from coronary heart disease: The Framingham study . JAMA 215:1617-1625, 1971;.
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Shu CY:  Mobile CCUs . Hospitals 45:14, 1971;.
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Pantridge JF:  The effect of early therapy on the hospital mortality from acute myocardial infarction . Q J Med 39:621-622, 1970;.
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Copley DP, Mantle JA, Rogers WJ, et al:  Improved outcome from prehospital cardiopulmonary collapse with resuscitation by bystanders . Circulation 56:901-905, 1977;.
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Baum RS, Alvarez H, Cobb LA:  Survival after resuscitation from out-of-hospital ventricular fibrillation . Circulation 50:1231-1235, 1974;.
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Schaffer WA, Cobb LA:  Recurrent ventricular fibrillation and modes of death in survivors of out-of-hospital ventricular fibrillation . N Engl J Med 293:259-262, 1975;.
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Thompson RG, Hallstrom AP, Cobb LA:  Beneficial effect of bystander initiated CPR in out-of-hospital ventricular fibrillation . Circulation 56( (suppl 3) ):111-114, 1977;.
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Gordon T, Kannel WB, McGee D, et al:  Death and coronary attacks in men after giving up cigarette smoking: A report from the Framingham study . Lancet 2:1345-1348, 1974;.
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Wilhelmeson G, Vedin JA, Elmfeldt D, et al:  Smoking and myocardial infarction . Lancet 1:415-420, 1975;.
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Cryer PE, Raymond MW, Santiago JV, et al:  Norepinephrine and epinephrine release and adrenergic mediation of smoking-associated hemodynamic metabolic events . N Engl J Med 295:573-577, 1976;.
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Verrier RL, Thompson PL, Lown B:  Ventricular vulnerability during sympathetic stimulation: Role of heart rate and blood pressure . Cardiovasc Res 8:602-610, 1974;.
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Verrier RL, Calvert A, Lown B:  Effect of posterior hypothalamic stimulation on ventricular fibrillation threshold . Am J Physiol 228:923-927, 1975;.
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Bellet S, DeGuzman NT, Kostis JB, et al:  The effect of inhalation of cigarette smoke on ventricular fibrillation threshold in normal dogs and dogs with acute myocardial infarction . Am Heart J 83:67-76, 1972;.
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Farquhar JW, Maccoby N, Wood PD, et al:  Community education for cardiovascular health . Lancet 1:1192-1195, 1977;.
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A Manual for Instructors of Basic Cardiac Life Support . Dallas, AHA, 1977;.
76 +
Webb DD, Lambrew C:  Evaluation of physician skills in cardiopulmonary resuscitation . JACEP 7:387-389, 1978;.
77 +
Lambrew CT:  The experience in telemetry of the electrocardiogram to a base hospital . Heart Lung 3:756-764, 1974;.
78 +
Stamler J:  Sudden coronary death: Approaches to its prevention . Med Clin North Am 60:245-282, 1976;.
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Kannel WB:  Prevention of cardiovascular disease . Curr Probl Cardiol 1:5-68, 1976;.
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Epstein FH:  The epidemiology of coronary heart disease: A review . J Chronic Dis 18:735-774, 1965;.
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Kannel WB, Castelli WP, Gordon T, et al:  Serum cholesterol, lipoproteins, and the risk of coronary heart disease: The Framingham study . Ann Intern Med 74:1-12, 1971;.
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Friedman M, Rosenman RH:  Type A behavior pattern: Its association with coronary heart disease . Ann Clin Res 3:300-312, 1971;.
83 +
McNamara JJ, Molot MA, Stremple JF, et al:  Coronary artery disease in combat casualties in Vietnam . JAMA 216:1185-1187, 1971;.
84 +
Guildner CW:  Resuscitation—opening the airway: A comparative study of techniques for opening an airway obstructed by the tongue . JACEP 5:588-590, 1976;.
85 +
Proceedings of the National Conference on Standards for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) , AHA and National Academy of Sciences, National Research Council, 1973;.
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Safar P, Escarraga L, Elam J:  A comparison of the mouth-to-mouth-to-airway methods of artificial respiration with the chestpressure arm-lift methods . N Engl J Med 258:671-677, 1958;.
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Safar P:  Ventilatory efficacy of mouth-to-mouth artificial respiration: Airway obstruction during manual and mouth-to-mouth artificial respiration . JAMA 167:335-341, 1958;.
88 +
Safar P, Escarraga L, Chang F:  Upper airway obstruction in the unconscious patient . J Appl Physiol 14:760-764, 1959;.
89 +
Morikawa S, Safar P, DeCarlo J:  Influence of the head-jaw position upon upper airway patency . Anesthesiology 22:265-270, 1961;.
90 +
Safar P: Respiratory Therapy . Philadelphia, FA Davis Co, 1965;,  chap 3 and 4 .
91 +
Elam JO, Greene DG, Schneider MA, et al:  Head-tilt method of oral resuscitation . JAMA 172:812-815, 1960;.
92 +
Ruben HM, Elam JO, Ruben AM:  Investigation of upper airway problems in resuscitation . Anesthesiology 22:271-279, 1961;.
93 +
Greene DG, Elam JO, Dobkin AB, et al:  Cinefluorographic study of hyperextension of the neck and upper airway patency . JAMA 176:570-573, 1961;.
94 +
Ruben H, Knudsen EJ, Carugati G:  Gastric inflation in relation to airway pressure . Acta Anaesthesiol Scand 5:107-114, 1961;.
95 +
Brown HG:  The applied anatomy of vomiting . Br J Anaesthesiol 35:136-145, 1963;.
96 +
Stept WJ, Safar P:  Rapid induction-intubation for prevention of gastric content aspiration . Anesthesiol Analg 49:633-636, 1970;.
97 +
Haugen RK:  The cafe coronary: Sudden deaths in restaurants . JAMA 186:142-143, 1963;.
98 +
Ruben H, MacNaughton FI:  The treatment of food-choking . Practitioner 221:725-729, 1978;.
99 +
Gordon AS, Belton MK, Ridolpho PF:  Emergency management of foreign body airway obstruction , in Safar P, Elam JO (eds): Advances in Cardiopulmonary Resuscitation . New York, Springer-Verlag Inc, 1977;, pp 39-50.
100 +
Guildner CW, Williams D, Subitch T:  Airway obstructed by foreign material: The Heimlich maneuver . JACEP 5:675-677, 1976;.
101 +
Visintine RE, Baick CH:  Ruptured stomach after Heimlich maneuver . JAMA 234:415, 1975;.
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Palmer E:  The Heimlich maneuver misused . Current Prescribing 5:45-49, 1979;.
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Heimlich HJ:  A life-saving maneuver to prevent food-choking . JAMA 234:398-401, 1975;.
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Heimlich HJ:  Pop goes the cafe coronary . Emergency Med 6:154-155, 1974;.
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Heimlich HJ, Hoffman KA, Canestri FR:  Food-choking and drowning deaths prevented by external subdiaphragmatic compression: Physiological basis . Ann Thorac Surg 20:188-195, 1975;.
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Redding JS:  The choking controversy: Critique of evidence on the Heimlich maneuver . Crit Care Med 7:475-479, 1979;.
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Chandra N, Rudikoff M, Weisfeldt ML:  Simultaneous chest compressions and ventilation at high airway pressure during cardiopulmonary resuscitation (CPR) in man . Circulation 58( (suppl 2) ):203, 1978;.
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Rudikoff MT, Freund D, Weisfeldt ML:  Mechanism of blood flow during cardiopulmonary resuscitation . Circulation 56( (suppl 3) ):97, 1977;.
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Neimann JT, Garner D, Rosborough J, et al:  The mechanism of blood flow in closed chest cardiopulmonary resuscitation . Circulation 60( (suppl 2) ):74, 1979;.
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Criley JM, Blaufuss AH, Kissel GL:  Cough-induced cardiac compression: Self-administered form of cardiopulmonary resuscitation: JAMA 236:1246-1250, 1976;.
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Safar P, Brown TC, Holtey WJ, et al:  Ventilation and circulation with closed-chest cardiac massage in man . JAMA 176:574-576, 1961;.
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To understand the clinical management of acute heart failure syndromes.
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