Abstract
The framework of basic CPR methods or techniques, namely artificial respiration, closed chest cardiac compression (CCCC), electric defibrillation and drug therapy, especially epinephrine administration, were developed during the first half of the 20th century. It can be said it was completed when Kouwenhoven introduced CCCC in 1960.
In 1974, American Heart Association and its related organizations collaborated to publish the first CPR guidelines. Since then they have revised the Guidelines every several years to renew the methods and techniques according to accumulated new achievements during these periods.
In 2000, it published the 7th edition (G2000) in collaboration with ILCOR, the International Liaison Committee On Resuscitation. Because of this it can be said that G2000 is the resuscitation guideline of the world.
One of the rules for the AHA guidelines is that it admits only methods which have bad their efficacy verified scientifically in humans, and G2000 emphasized the importance of evidence-based medicine in the science of resuscitation. But some of the methods have been used on an empirical basis without scientific proof of their efficacy. Some of the methods have been used without knowing the mechanisms by which they work on human. For example, CCCC was used for a long time without knowing logically its mechanism of pumping out the blood by simply compressing the sternum. The optimal dose of epinephrine when the initial dose of the drug fails has been controversial for long time.
Recently, new problems such as an avoidance of mouth to mouth respiration have arisen and caused some changes in the framework of CPR techniques. In this article I would like to discuss some of the problematic issues of CPR such as the following :
1. The mechanisms of CCCC by which blood flows by simply compressing the sternum
2. It has long been known that weak electric current causes ventricular fibrillation and strong one defibrillation. Why is that? And what is the optimal current for defibrillating?
3. Mouth to mouth respiration is far better in effectiveness than other types of basic artificial respiration. But recently not many citizens have been willing to practice it on a stranger. Because of this G2000 approved the use of compression—only CPR. How effective is it?
4. If the initial dose of epinephrine is ineffective the use of a dose of epinephrine that's 5-10 times greater is approved to use as a subsequent dose. What are the right doses of epinephrine in resuscitation?
5. Hypothermia is attracting the interest of clinicians because of its probable effects in brain resuscitation after successful cardiopulmonary resuscitation. What is the conclusion of recent studies on this matter?
Is it the best remedy for brain resuscitation?
