0
April 26, 1985, Vol 253, No. 16 >
ARTICLE | April 26, 1985

Prehospital Cardiopulmonary Resuscitation: Title and subTitle BreakIs It Effective? FREE

Richard O. Cummins, MD, MPH, MSc; Mickey S. Eisenberg, MD, PhD
[+] Author Affiliations

Reprint requests to Room 508 Smith Tower, 506 Second Ave, Seattle, WA 98104 (Dr Cummins).


JAMA. 1985;253(16):2408-2412. doi:10.1001/jama.1985.03350400092028
Text Size: A A A
Published online
Article
References

TWO PARADOXES lie behind the question posed in the title of this article. First, rapid and widespread dissemination of the technique of cardiopulmonary resuscitation (CPR) occured before the underlying physiology was fully understood. Second, data that indicate discouragingly low coronary and carotid artery flow rates contrast sharply with the obvious lifesaving capacity of basic CPR.

CPR  In the early 1960s, Kouwenhoven et al1 demonstrated the effectiveness of closed-chest compressions for cardiac arrest; rapid worldwide dissemination of the technique soon followed. By 1974, the endorsement of influential groups such as the American Heart Association secured broad acceptance for standard CPR.2 Kouwenhoven and co-workers thought that during CPR blood was expelled by compression of the heart between the sternum and vertebral bodies. Later, however, various research laboratories conducted what were, in effect, post hoc investigations into the physiology of CPR; by the 1980s, few researchers subscribed to Kouwenhoven and co-workers'

REFERENCES

1 +
Kouwenhoven WB, Jude JR, Knickerbocker GG:  Closed-chest cardiac massage . JAMA 1960;; 173:1064-1067.
2 +
Gordon AS (chairman):  Standards for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) . JAMA 1974;; 227( (suppl) ):833-868.
3 +
Luce JM, Cary JM, Ross BK, et al:  New developments in cardiopulmonary resuscitation . JAMA 1980;;244:1366-1370.
4 +
Weisfeldt ML:  Cardiopulmonary resuscitation: Issues and controversy . Emerg Med Ann 1982;;1:1-11.
5 +
Niemann JT, Rosborough JR, Criley JR, et al:  Perfusion during cardiopulmonary resuscitation: Traditional concepts and recent advances . in Harwood AL (ed): Cardiopulmonary Resuscitation . Baltimore, Williams & Wilkins Co, 1982;, pp 34-54.
6 +
White JD.  The new CPR , in Jacobson S (ed): Resuscitation . New York, Churchill Livingstone, 1983;, pp 27-37.
7 +
White BC, Wiegenstein JG, Winegar CD:  Brain ischemic anoxia: Mechanisms of injury . JAMA 1984;:251:1586-1590.
8 +
White BC, quoted by Sellers T:  Now the question: 'Does CPR do more harm than good?' Emery Dept News , (December) 1982;, p 1.
9 +
Babbs CF, Voorhees WD, Fitzgerald KR, et al:  Relationship of blood pressure and flow during CPR to chest compression amplitude: Evidence for an effective compression threshold . Ann Emerg Med 1983;;12:527-532.
10 +
Luce JM, Ross BK, O'Quinn RJ, et al:  Regional blood flow during cardiopulmonary resuscitation in dogs using simultaneous and nonsimultaneous compression and ventilation . Circulation 1983;:67:258-265.
11 +
Voorhees WD III, Ralston SH, Babbs CF:  Regional blood flow during cardiopulmonary resuscitation with abdominal counterpulsation in dogs . Am J Emerg Med 1984;;2:123-128.
12 +
Koehler RC, Chandra N, Guerci AD, et al:  Augmentation of cerebral perfusion by simultaneous chest compression and lung inflation with abdominal binding after cardiac arrest in dogs . Circulation 1983;;67:266-275.
13 +
Mahoney B, Mirick MJ;  Efficacy of pneumatic trousers in refractory prehospital cardiopulmonary arrest . Ann Emerg Med 1983;;12:8-12.
14 +
Cobb LA, Hallstrom AP:  Communitybased cardiopulmonary resuscitation: What have we learned? Ann NY Acad Sci 1982;;382:330-342.
15 +
Cobb LA, Hallstrom AP, Thompson RG, et al:  Community cardiopulmonary resuscitation . Ann Rev Med 1980;;31: 453-462.
16 +
Carter WB, Eisenberg MS, Hallstrom AP, et al:  Development and implementation of emergency CPR instructions via telephone . Ann Emerg Med 1984;;13(pt (1) ):695-700.
17 +
Martin WJ, Loomis JH, Lloyd CW:  Cardiopulmonary resuscitation skills: Do we expect too much? Arch Intern Med 1984;;144:699-701.
18 +
Kouwenhoven WB:  The development of the defibrillator . Ann Intern Med 1969;;71:449-458.
19 +
Eisenberg MS:  Who shall live? Who shall die? , in Eisenberg MS, Bergner L, Hallstrom AP (eds): Sudden Cardiac Death in the Community . New York, Praeger Publishing, 1984;, pp 44-58.
20 +
Lund I, Skulberg A:  Cardiopulmonary resuscitation by lay people . Lancet 1976;;2:702-704.
21 +
Copley DP, John AM, Rogers WJ, et al:  Improved outcome for prehospital cardiopulmonary collapse with resuscitation by bystanders . Circulation 1977;;56:901-905.
22 +
Thompson RG, Hallstrom AP, Cobb LA:  Bystander-initiated cardiopulmonary resuscitation in the management of ventricular fibrillation . Ann Intern Med 1979;;90:737-740.
23 +
Tweed WA, Bristow G, Donen N:  Resuscitation from cardiac arrest: Assessment of a system providing only basic life support outside of hospital . Can Med Assoc J 1980;;122:297-300.
24 +
Gudjonsson H, Baldvinsson E, Oddsson G, et al:  Results of attempted cardiopulmonary resuscitation of patients dying suddenly outside the hospital in Reykjavik and the surrounding area, 1976-1979 . Acta Med Scand 1982;;212:247-251.
25 +
Vertesi L, Wilson L, Glick N:  Cardiac arrest: Comparison of paramedic and conventional ambulance services . Can Med Assoc J 1983;;128:809-813.
26 +
Guzy PM, Pearce ML, Greenfield S:  The survival benefit of bystander cardiopulmonary resuscitation in a paramedic-served metropolitan area . Am J Public Health 1983;;73:766-769.
27 +
Eisenberg M, Bergner L, Hallstrom A:  Paramedic programs and out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation . Am J Public Health 1979;;69:30-38.
28 +
Roth R, Stewart RD, Rogers K, et al:  Out-of-hospital cardiac arrest: Factors associated with survival . Ann Emerg Med 1984;;13:237-243.
29 +
Pionkowski RS, Thompson BM, Gruchow HW, et al:  Resuscitation time in ventricular fibrillation—a prognostic indicator . Ann Emerg Med 1983;;12:733-738.
30 +
Eisenberg MS, Copass MK, Hallstrom AP, et al:  Management of out-of-hospital cardiac arrest: Failure of basic emergency medical technician services . JAMA 1980;;243:1049-1051.
31 +
Enns J, Tweed WA, Donen N:  Prehospital cardiac rhythm deterioration in a system providing only basic life support . Ann Emerg Med 1983;;12:478-481.
32 +
Ritter G, Goldstein S, Leighton R, et al:  The effect of bystander CPR and arrival time on successful out-of-hospital resuscitation , abstracted. Am J Emerg Med 1984;;2:358-359.
33 +
Bergner L, Bergner M, Hallstrom AP, et al:  Service factors and health status of survivors of out-of-hospital cardiac arrest . Am J Emerg Med 1983;;1:259-263.
34 +
Cummins RO, Eisenberg MS, Hallstrom AP, et al:  The survival benefit of bystander CPR for sudden cardiac death , abstracted. Am J Emerg Med 1984;;2:349.
35 +
Stults KR, Brown DD, Schug VL, et al:  Prehospital defibrillation performed by emergency medical technicians in rural communities . N Engl J Med 1984;;310:219-223.

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 +
Kouwenhoven WB, Jude JR, Knickerbocker GG:  Closed-chest cardiac massage . JAMA 1960;; 173:1064-1067.
2 +
Gordon AS (chairman):  Standards for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) . JAMA 1974;; 227( (suppl) ):833-868.
3 +
Luce JM, Cary JM, Ross BK, et al:  New developments in cardiopulmonary resuscitation . JAMA 1980;;244:1366-1370.
4 +
Weisfeldt ML:  Cardiopulmonary resuscitation: Issues and controversy . Emerg Med Ann 1982;;1:1-11.
5 +
Niemann JT, Rosborough JR, Criley JR, et al:  Perfusion during cardiopulmonary resuscitation: Traditional concepts and recent advances . in Harwood AL (ed): Cardiopulmonary Resuscitation . Baltimore, Williams & Wilkins Co, 1982;, pp 34-54.
6 +
White JD.  The new CPR , in Jacobson S (ed): Resuscitation . New York, Churchill Livingstone, 1983;, pp 27-37.
7 +
White BC, Wiegenstein JG, Winegar CD:  Brain ischemic anoxia: Mechanisms of injury . JAMA 1984;:251:1586-1590.
8 +
White BC, quoted by Sellers T:  Now the question: 'Does CPR do more harm than good?' Emery Dept News , (December) 1982;, p 1.
9 +
Babbs CF, Voorhees WD, Fitzgerald KR, et al:  Relationship of blood pressure and flow during CPR to chest compression amplitude: Evidence for an effective compression threshold . Ann Emerg Med 1983;;12:527-532.
10 +
Luce JM, Ross BK, O'Quinn RJ, et al:  Regional blood flow during cardiopulmonary resuscitation in dogs using simultaneous and nonsimultaneous compression and ventilation . Circulation 1983;:67:258-265.
11 +
Voorhees WD III, Ralston SH, Babbs CF:  Regional blood flow during cardiopulmonary resuscitation with abdominal counterpulsation in dogs . Am J Emerg Med 1984;;2:123-128.
12 +
Koehler RC, Chandra N, Guerci AD, et al:  Augmentation of cerebral perfusion by simultaneous chest compression and lung inflation with abdominal binding after cardiac arrest in dogs . Circulation 1983;;67:266-275.
13 +
Mahoney B, Mirick MJ;  Efficacy of pneumatic trousers in refractory prehospital cardiopulmonary arrest . Ann Emerg Med 1983;;12:8-12.
14 +
Cobb LA, Hallstrom AP:  Communitybased cardiopulmonary resuscitation: What have we learned? Ann NY Acad Sci 1982;;382:330-342.
15 +
Cobb LA, Hallstrom AP, Thompson RG, et al:  Community cardiopulmonary resuscitation . Ann Rev Med 1980;;31: 453-462.
16 +
Carter WB, Eisenberg MS, Hallstrom AP, et al:  Development and implementation of emergency CPR instructions via telephone . Ann Emerg Med 1984;;13(pt (1) ):695-700.
17 +
Martin WJ, Loomis JH, Lloyd CW:  Cardiopulmonary resuscitation skills: Do we expect too much? Arch Intern Med 1984;;144:699-701.
18 +
Kouwenhoven WB:  The development of the defibrillator . Ann Intern Med 1969;;71:449-458.
19 +
Eisenberg MS:  Who shall live? Who shall die? , in Eisenberg MS, Bergner L, Hallstrom AP (eds): Sudden Cardiac Death in the Community . New York, Praeger Publishing, 1984;, pp 44-58.
20 +
Lund I, Skulberg A:  Cardiopulmonary resuscitation by lay people . Lancet 1976;;2:702-704.
21 +
Copley DP, John AM, Rogers WJ, et al:  Improved outcome for prehospital cardiopulmonary collapse with resuscitation by bystanders . Circulation 1977;;56:901-905.
22 +
Thompson RG, Hallstrom AP, Cobb LA:  Bystander-initiated cardiopulmonary resuscitation in the management of ventricular fibrillation . Ann Intern Med 1979;;90:737-740.
23 +
Tweed WA, Bristow G, Donen N:  Resuscitation from cardiac arrest: Assessment of a system providing only basic life support outside of hospital . Can Med Assoc J 1980;;122:297-300.
24 +
Gudjonsson H, Baldvinsson E, Oddsson G, et al:  Results of attempted cardiopulmonary resuscitation of patients dying suddenly outside the hospital in Reykjavik and the surrounding area, 1976-1979 . Acta Med Scand 1982;;212:247-251.
25 +
Vertesi L, Wilson L, Glick N:  Cardiac arrest: Comparison of paramedic and conventional ambulance services . Can Med Assoc J 1983;;128:809-813.
26 +
Guzy PM, Pearce ML, Greenfield S:  The survival benefit of bystander cardiopulmonary resuscitation in a paramedic-served metropolitan area . Am J Public Health 1983;;73:766-769.
27 +
Eisenberg M, Bergner L, Hallstrom A:  Paramedic programs and out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation . Am J Public Health 1979;;69:30-38.
28 +
Roth R, Stewart RD, Rogers K, et al:  Out-of-hospital cardiac arrest: Factors associated with survival . Ann Emerg Med 1984;;13:237-243.
29 +
Pionkowski RS, Thompson BM, Gruchow HW, et al:  Resuscitation time in ventricular fibrillation—a prognostic indicator . Ann Emerg Med 1983;;12:733-738.
30 +
Eisenberg MS, Copass MK, Hallstrom AP, et al:  Management of out-of-hospital cardiac arrest: Failure of basic emergency medical technician services . JAMA 1980;;243:1049-1051.
31 +
Enns J, Tweed WA, Donen N:  Prehospital cardiac rhythm deterioration in a system providing only basic life support . Ann Emerg Med 1983;;12:478-481.
32 +
Ritter G, Goldstein S, Leighton R, et al:  The effect of bystander CPR and arrival time on successful out-of-hospital resuscitation , abstracted. Am J Emerg Med 1984;;2:358-359.
33 +
Bergner L, Bergner M, Hallstrom AP, et al:  Service factors and health status of survivors of out-of-hospital cardiac arrest . Am J Emerg Med 1983;;1:259-263.
34 +
Cummins RO, Eisenberg MS, Hallstrom AP, et al:  The survival benefit of bystander CPR for sudden cardiac death , abstracted. Am J Emerg Med 1984;;2:349.
35 +
Stults KR, Brown DD, Schug VL, et al:  Prehospital defibrillation performed by emergency medical technicians in rural communities . N Engl J Med 1984;;310:219-223.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems