ADVANCED CARDIAC LIFE-SUPPORT - UPDATE ON RECENT GUIDELINES AND A LOOK AT THE FUTURE

The objectives of this article are to provide an update of the America n Heart Association (AHA) 1992 National Conference guidelines for card iopulmonary resuscitation (CPR) and emergency cardiac care and to revi ew the investigation and development of new methods of CPR which may b e considered in future recommendations. Despite an organized approach to sudden cardiac arrest, survival in patients receiving CPR is in the range of 5-15%. The new AHA guidelines recommend standard manual CPR performed at a rate of 80-100 compressions/min and organized algorithm s of advanced cardiac life support. These guidelines stress widespread community training and rapid response in the following sequence: (1) recognition of early warning signs, (2) activation of the emergency me dical system (EMS), (3) basic CPR, (4) early defibrillation, (5) intub ation, acid (6) intravenous medication. Several new recommendations pe rtain specifically to in-hospital care and are, therefore, particularl y relevant to physician management of cardiac arrest. The best predict or of survival in patients requiring circulatory support after cardiac arrest is attainable coronary and cerebral perfusion. Unfortunately t he minimal levels of end-organ perfusion required to sustain life are often difficult or impossible to achieve with standard manual cardiopu lmonary resuscitation and several new techniques have therefore been i ntroduced. The most promising of these techniques are (1) interposed a bdominal compression, (2) pneumatic vest, and (3) active compression-d ecompression resuscitation. Each of these techniques offers unique adv antages when compared with standard manual cardiopulmonary resuscitati on. The 1992 National Conference recommendations provide a rational fr amework for the resuscitation of cardiac arrest victims. New methods o f cardiopulmonary resuscitation are now available and investigation in to these methods continues. In the future, these modalities may be inc orporated in newer guidelines and be available on a widespread basis t o supplement our current approach to cardiac arrest.