Annals of emergency medicine
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External defibrillation was first reported in 1956, mouth-to-mouth ventilation was first reported in 1958, and closed-chest compression in 1960. While these developments began the modern era of CPR, accounts of resuscitative efforts go back to ancient times. ⋯ This issue of the Annals of Emergency Medicine contains the proceedings of the most recent National Conference on CPR and ECC. At this conference, a consensus was reached by an international gathering of scientists and clinicians for guidelines on adult basic and advanced life support, as well as on pediatric and neonatal life support.
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To improve emergency cardiac care (ECC) on the national or international level, we must translate to the rest of our communities the successes found in cities with high survival rates. In recent years, important developments have evolved in our understanding of the treatment and evaluation of cardiac arrest. Some of the most important of these developments include 1) recognition of the chain of survival, which is necessary to achieve high survival rates; 2) widespread acceptance that survival rates must be assessed routinely to ensure continuous quality improvements in the emergency medical services (EMS) system; and 3) development of improved methods for performing survival rate studies that will maximize the effectiveness of information gathering and analysis. ⋯ Therefore, the 1992 National Conference on CPR and ECC strongly endorses the position that all ECC systems assess their survival rates through an ongoing quality improvement process and that all members of the chain of providers should be represented in the outcome assessment team. We still have much to discover regarding optimal techniques of CPR, methods for data collection, and optimal structure of an EMS system. Research in these areas will provide the foundation for future changes in EMS systems development.
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Since 1985, it has become apparent that the key to survival from adult sudden cardiac death is prompt defibrillation. Any delay from the time of collapse to the initial countershock will decrease the likelihood of survival. It also has been determined that CPR performed by lay rescuers is not begun promptly and, once started, often is performed for more than one minute before the emergency medical services (EMS) system is accessed, which significantly delays the time to defibrillation. ⋯ Therefore, a rescuer should perform one minute of rescue support before activating the EMS system (a concept termed phone fast). It is recognized that this change is dependent upon a national EMS system that is still evolving. It is hoped that this change to phone first and phone fast will provide an impetus for rapid development of the EMS infrastructure.
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The concept of the chain of survival for children has been extended to include prevention, bystander CPR, prehospital CPR, and acute care. Two clinical cases are presented as examples. The current status and possible weaknesses in each link of the chain are discussed, and suggestions are made for possible research initiatives.
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CPR in infants and children has a number of unique clinical, legal, and ethical aspects. The distinguishing clinical aspects relate to the circumstances of pediatric cardiopulmonary arrest and their prognostic implications. The relevant legal and ethical considerations derive from the special triadic physician-child-parent relationship, the standing of parents as surrogate decision makers, and the progressive development of decisional capacity in maturing children. This paper discusses the implications of guidelines and policies concerning decisions to provide, withhold, or withdraw CPR and life support systems.