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September 22, 1993, Vol 270, No. 12 >
ARTICLE | September 22, 1993

Prehospital Resuscitation: Title and subTitle BreakThe Good, the Bad, and the Futile FREE

William A. Gray, MD
[+] Author Affiliations

Reprint requests to Southwest Cardiology Associates PA, 1101 Medical Arts Ave NE, Bldg 5, Albuquerque, NM 87102 (Dr Gray).


JAMA. 1993;270(12):1471-1472. doi:10.1001/jama.1993.03510120093038
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References

Over the past two decades, the provision of advanced cardiac life support (ACLS) in the prehospital arena has been established and refined in many communities throughout the United States and other industrialized countries. Whereas in the late 1960s no one was given much hope of surviving an out-of-hospital cardiac arrest, today, in cities like Seattle, Milwaukee, and Miami, rates of hospital discharge for cardiac arrest due to ventricular fibrillation hover around 25% to 30%.1-3 This has been accomplished only by applying the lessons learned from research on the subject, which have been incorporated into the "chain of survival" developed by the American Heart Association.4 The first link in the chain is establishing systems for rapid public access to emergency medical care (eg, by telephoning 911). The second link is widespread public training in cardiopulmonary resuscitation (CPR) techniques (eg, in Houston, Tex, certification in CPR is a routine part

REFERENCES

1 +
Weaver WD, Cobb LA, Hallstrom AP, et al.  Considerations for improving survival from out-of-hospital cardiac arrest. Ann Emerg Med . 1986;;15:1181-1186.
2 +
Aprahamian C, Thompson BM, Gruchow HW, et al.  Decision making in prehospital sudden cardiac arrest. Ann Emerg Med . 1986;;15:445-449.
3 +
Myerburg RJ, Kessler KM, Zaman L, Conde CA, Castellanos A.  Survivors of prehospital cardiac arrest. JAMA . 1982;;247:1485-1490.
4 +
Emergency Cardiac Care Committee and Subcommittees, American Heart Association.  Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA . 1992;;268:2171-2302.
5 +
Eisenberg MS, Horwood BT, Cummins RO, Reynolds-Haertle R, Hearne TR.  Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med . 1990;;19:179-186.
6 +
Gray WA, Capone RJ, Most AS.  Unsuccessful emergency medical resuscitation— are continued efforts in the emergency department justified? N Engl J Med . 1991;; 325:1393-1398.
7 +
Bachman JW, McDonald GS, O'Brien PC.  A study of out-of-hospital cardiac arrests in northeastern Minnesota. JAMA . 1986;;256:477-483.
8 +
Weaver WD, Hill D, Fahrenbruch CE, et al.  Use of the automatic external defibrillator in the management of out-of-hospital cardiac arrest. N Engl J Med . 1988;;319:661-666.
9 +
Kellermann AL, Hackman BB, Somes G.  Predicting the outcome of unsuccessful prehospital advanced cardiac life support. JAMA . 1993;;270:1433-1436.
10 +
Bonnin MJ, Pepe PE, Kimball KT, Clark PS.  Distinct criteria for termination of resuscitation in the out-of-hospital setting. JAMA . 1993;;270:1457-1462.
11 +
Lewis LM, Ruoff B, Rush C, Stothert JC.  Is emergency department resuscitation of out-of-hospital cardiac arrest victims who arrive pulseless worthwhile? Am J Emerg Med . 1990;;8:118-120.
12 +
Bonnin MJ, Swor RA.  Outcomes in unsuccessful field resuscitation attempts. Ann Emerg Med . 1989;;18:507-512.
13 +
Kellermann AL, Staves DR, Hackman BB.  In-hospital resuscitation following unsuccessful prehospital advanced cardiac life support: 'heroic efforts' or an exercise in futility? Ann Emerg Med . 1988;;17:589-594.
14 +
Wolford RW, Kaplan RM, Stewart RD, Paris PM.  ALS witnessed prehospital cardiopulmonary arrest. Ann Emerg Med . 1988;;17:410.
15 +
Jakobsson J, Nyquist 0, Rehnqvist N, et al.  Prognosis and clinical follow-up of patients resuscitated from out-of-hospital cardiac arrest. Acta Med Scand . 1987;;222: 123-132.
16 +
Geehr PC, Lewis FR, Auerbach PS.  Failure of open-heart massage to improve survival after prehospital nontraumatic cardiac arrest. N Engl J Med . 1986;;314: 1189-1190.
17 +
Warner LL, Hoffman JR, Baraff LJ.  Prognostic significance of field response in out-of-hospital ventricular fibrillation. Chest . 1985;;87:22-28.
18 +
Bedell SE, Delbanco TL, Cook EF, Epstein FH.  Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med . 1983;;309:569-576.
19 +
Cummins RO, Eisenberg MS, Hallstrom AP, Litwin PE.  Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. Am J Emerg Med . 1985;;3:114-119.
20 +
Bellamy RF, DeGuzman LR, Pedersen DC.  Coronary blood flow during cardiopulmonary resuscitation in swine. Circulation . 1984;;69:174-180.
21 +
Ditchey RV, Winkler JV, Rhodes CA.  Relative lack of coronary blood flow during closed-chest resuscitation in dogs. Circulation . 1982;;66:297-302.
22 +
Luce JM, Ross BK, O'Quin RJ, et al.  Regional blood flow during cardiopulmonary resuscitation in dogs using simultaneous and nonsimultaneous compression and ventilation. Circulation . 1983;;67:258-265.
23 +
Gray WA.  The out-of-hospital cardiac arrest: the case for uniformity in the approach to resuscitation. J Irish Coll Physicians Surg . In press.
24 +
Gregory JJ, Kerwin J.  Resuscitation after cardiac arrest outside the hospital. N Engl J Med . 1992;;326:1496.

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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 +
Weaver WD, Cobb LA, Hallstrom AP, et al.  Considerations for improving survival from out-of-hospital cardiac arrest. Ann Emerg Med . 1986;;15:1181-1186.
2 +
Aprahamian C, Thompson BM, Gruchow HW, et al.  Decision making in prehospital sudden cardiac arrest. Ann Emerg Med . 1986;;15:445-449.
3 +
Myerburg RJ, Kessler KM, Zaman L, Conde CA, Castellanos A.  Survivors of prehospital cardiac arrest. JAMA . 1982;;247:1485-1490.
4 +
Emergency Cardiac Care Committee and Subcommittees, American Heart Association.  Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA . 1992;;268:2171-2302.
5 +
Eisenberg MS, Horwood BT, Cummins RO, Reynolds-Haertle R, Hearne TR.  Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med . 1990;;19:179-186.
6 +
Gray WA, Capone RJ, Most AS.  Unsuccessful emergency medical resuscitation— are continued efforts in the emergency department justified? N Engl J Med . 1991;; 325:1393-1398.
7 +
Bachman JW, McDonald GS, O'Brien PC.  A study of out-of-hospital cardiac arrests in northeastern Minnesota. JAMA . 1986;;256:477-483.
8 +
Weaver WD, Hill D, Fahrenbruch CE, et al.  Use of the automatic external defibrillator in the management of out-of-hospital cardiac arrest. N Engl J Med . 1988;;319:661-666.
9 +
Kellermann AL, Hackman BB, Somes G.  Predicting the outcome of unsuccessful prehospital advanced cardiac life support. JAMA . 1993;;270:1433-1436.
10 +
Bonnin MJ, Pepe PE, Kimball KT, Clark PS.  Distinct criteria for termination of resuscitation in the out-of-hospital setting. JAMA . 1993;;270:1457-1462.
11 +
Lewis LM, Ruoff B, Rush C, Stothert JC.  Is emergency department resuscitation of out-of-hospital cardiac arrest victims who arrive pulseless worthwhile? Am J Emerg Med . 1990;;8:118-120.
12 +
Bonnin MJ, Swor RA.  Outcomes in unsuccessful field resuscitation attempts. Ann Emerg Med . 1989;;18:507-512.
13 +
Kellermann AL, Staves DR, Hackman BB.  In-hospital resuscitation following unsuccessful prehospital advanced cardiac life support: 'heroic efforts' or an exercise in futility? Ann Emerg Med . 1988;;17:589-594.
14 +
Wolford RW, Kaplan RM, Stewart RD, Paris PM.  ALS witnessed prehospital cardiopulmonary arrest. Ann Emerg Med . 1988;;17:410.
15 +
Jakobsson J, Nyquist 0, Rehnqvist N, et al.  Prognosis and clinical follow-up of patients resuscitated from out-of-hospital cardiac arrest. Acta Med Scand . 1987;;222: 123-132.
16 +
Geehr PC, Lewis FR, Auerbach PS.  Failure of open-heart massage to improve survival after prehospital nontraumatic cardiac arrest. N Engl J Med . 1986;;314: 1189-1190.
17 +
Warner LL, Hoffman JR, Baraff LJ.  Prognostic significance of field response in out-of-hospital ventricular fibrillation. Chest . 1985;;87:22-28.
18 +
Bedell SE, Delbanco TL, Cook EF, Epstein FH.  Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med . 1983;;309:569-576.
19 +
Cummins RO, Eisenberg MS, Hallstrom AP, Litwin PE.  Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. Am J Emerg Med . 1985;;3:114-119.
20 +
Bellamy RF, DeGuzman LR, Pedersen DC.  Coronary blood flow during cardiopulmonary resuscitation in swine. Circulation . 1984;;69:174-180.
21 +
Ditchey RV, Winkler JV, Rhodes CA.  Relative lack of coronary blood flow during closed-chest resuscitation in dogs. Circulation . 1982;;66:297-302.
22 +
Luce JM, Ross BK, O'Quin RJ, et al.  Regional blood flow during cardiopulmonary resuscitation in dogs using simultaneous and nonsimultaneous compression and ventilation. Circulation . 1983;;67:258-265.
23 +
Gray WA.  The out-of-hospital cardiac arrest: the case for uniformity in the approach to resuscitation. J Irish Coll Physicians Surg . In press.
24 +
Gregory JJ, Kerwin J.  Resuscitation after cardiac arrest outside the hospital. N Engl J Med . 1992;;326:1496.

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