Cardio-cerebral resuscitation is a new approach for treating patients experiencing primary cardiac arrest that emphasizes minimizing interruptions to chest compressions, passive ventilation, and early epinephrine administration. It has been shown to significantly increase survival rates compared to traditional CPR, which focused more on ventilations and allowed for interruptions in chest compressions. Cardiac arrest is a major public health problem, and solutions require accurately measuring the effectiveness of local resuscitation systems of care through data collection.

1. Cardio-cerebral resuscitation
Dr. Md.Toufiqur Rahman
MBBS, FCPS, MD, FACC, FESC, FRCPE, FSCAI,
FAPSC, FAPSIC, FAHA, FCCP, FRCPG
Associate Professor of Cardiology
National Institute of Cardiovascular Diseases,
Sher-e-Bangla Nagar, Dhaka-1207
Consultant, Medinova, Malibagh branch
Honorary Consultant, Apollo Hospitals, Dhaka and
STS Life Care Centre, Dhanmondi
drtoufiq19711@yahoo.com
CRT 2014
Washington
DC, USA

2. Cardiovascular disease is the major cause of mortality in the United
States, Canada, and Europe.
Unfortunately, the firstsign of cardiovascular disease is often the
last, as the first sign is often sudden death.
In the United States alone, thereare about 275,000 sudden deaths
per year from outofhospital cardiac arrests (OHCAs).
Despite national guidelinesand their near semi-
decennial update, the reported survival rates for OHCA between
1978 and 2008 remained unchanged at 7.6%.
Obviously, OHCA is a major public health problem that has not
previously been adequately addressed.
Patients with OHCA are not a homogeneous group.
Therefore, just looking at the overall survival of patients with OHCA
might not be the best indicator of the effectiveness of therapy.
Introduction

3. In-
hospital cardiac arrests are most often secondary to hypotension an
d shock, which is the end result of physiologicdeterioration from u
nderlying medical conditions such as infections, renal failure, an
emia, toxins, electrolyte imbalances,hypoxia, drugs, and trauma. In
these cases, the best approach is prevention, by treating the un
derlying disease to prevent the cardiac arrest.
"cardiocerebral resuscitation" approachhas resulted in a significant
improvement in the survival of patients with OHCA.
Classic cardiopulmonary resuscitation(CPR) should be reserved for
secondary cardiac arrest, secondary to respiratory insufficiency
from conditions such as,drowning, drug overdose, or advanced
pulmonary disease.
Introduction

4. The modern era of CPR began in 1960 at Johns Hopkins Hospital when Kouwenhoven
(a retired engineer), Jude (asurgical resident), and Knickerbocker (an engineer)
reported successful resuscitation of patients with cardiac arrest,without performing a
thoracotomy.
This approach was based on their experimental animal studies.
There were norandomized clinical trials assessing this technique or comparing it to
other approaches.
In the beginning, these pioneers taught that assisted ventilations were not necessary
during resuscitation efforts as theanimal gasped.
However, others thought that assisted ventilation was necessary, so mouthto-
mouth "rescue breathing"interposed between closed chest compressions became card
iopulmonary resuscitation, known as CPR.
Over the next50 years, using CPR meant performing chest compressions and assisted
ventilations.
It then became evident that most unexpected sudden deaths were not occurring in ho
spitals.
Historical Perspective

5. During the 1970s,researchers from Belfast, NY, and Seattle launched
programs in which medical care was delivered in the field by trainedmedics
who rode the ambulance services and were able to defibrillate patients in
the community who were in cardiac arrest.
This was a conceptual change in the way medical care for patients with
OHCA was delivered; initial emergencycare was delivered by nonphysicians
(i.e., paramedics) in the community under physicianguided protocols.
Soon thereafter, researchers again changed the paradigm by initiating care
for patients with cardiac arrest by laypersons.
Again, these major advances in treating patients with OHCA were not su
bjected to randomized clinicaltrials.
The ABCs (airway, breathing, compressions) of CPR became the standard of
care for patients with cardiac arrest.
Over approximately the past decade, the use of automated external
defibrillators has gained increasing importance.
Historical Perspective

7. There are two general types of cardiac arrest.
A primary cardiac arrest is an unexpected witnessed (seen or
heard) collapse in a person who is not responsive.
Gasping occurs in the majority (55%) of patients with OHCA,
and is often interpreted as breathing.
During primary cardiac arrest, the heart suddenly stops pumping blood
andthe arterial blood is oxygenated at the time of the arrest.
Secondary cardiac arrest is secondary to severe hypoxia, often from
drowning, respiratory failure, drug overdose,
or hypotension due to shock or hemorrhage.
In patients with cardiac arrest, each chest compression is the patient's
heart beat.
If chest compressions areinterrupted for any reason, blood flow to the
heart and brain essentially stops, decreasing the chance for
neurologically intact survival.

8. The previous fixation on ventilations interrupted essential blood flow to the bo
dy, and in the excitement ofresuscitation efforts, hyperventilation was
common.
A new approach for patients with primary cardiac arrest, called
cardiocerebral resuscitation, has been shown tosignificantly increase survival.
Studies in Arizona have shown that the survival rate of patients with OHCA is
significantly increased when COCPR is advocated and taught to the public.
For primary cardiac arrest, cardiocerebral resuscitation prohibits early
intubation, advocates passive ventilation,emphasizes minimal interruptions of
chest compressions, and encourages early administration of epinephrine.
For patients with ROSC but in a coma following cardiac arrest, new approaches
include therapeutic hypothermia,consideration of early cardiac catheterization
for those with possible acute coronary occlusion as the etiology oftheir arrest,
delay in terminating care, and appropriate intensive care.

14. Resuscitation science is a dynamic field.
Resuscitation of patients in cardiac arrest is dependent
on acarefully followed system of care and is no stronger
than its weakest link.
Cardiac arrest is a public health problem.
Assuch, solutions depend upon accurate data measuring
the effectiveness of the system of care.
Resuscitation science,both in the laboratory and in
clinical arenas, provides guides to developing the best
models of care to fit each community.
Conclusion

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Asia Pacific Congress of
Hypertension, 2014, February
Cebu city, Phillipines
Seminar on Management
of Hypertension,
Gulshan, Dhaka