Improving Outcomes from Resuscitation

Until the early 1950s, there did not exist any effective treatment for airway obstruction or cardiac arrest for laypersons. In the late 1950s, isolated steps were described to establish a patent airway (A), provide mouth-to-mouth breathing (B), and restore circulation (C) with chest compressions. Tying those steps together into an A-B-C sequence became the basis of physiologically effective cardiopulmonary-cerebral resuscitation, as the method was called originally.1Article see p 2173Although single steps proved to be effective, the outcomes of out-of-hospital cardiac arrest treated by cardiopulmonary-cerebral resuscitation were not encouraging from the very start. The efforts provided by bystanders and medical personnel came often “too little too late,”2 and there was a lack of specific therapies to treat the underlying causes or complications. The community-wide efforts of the public health organizations focused on the promotion of cardiopulmonary resuscitation, a newly coined term, now lacking the cerebral component.It is thus not surprising that the mainstay of further medical research focused mainly on the heart. Restoration of cardiac rhythm became an essential centerpiece of resuscitation efforts. Significant improvements in the survival of patients who had had a cardiac arrest were enabled by technological developments generally aimed to support the failing heart. The emergence of defibrillators in the 1960s, followed by percutaneous coronary interventions and mechanical devices supporting the failing heart granted the extra time to recover cardiac function in patients who would not have had the same chance several years ago. The brain as the key and target organ seemed somewhat left behind, at least in these early years. Indeed, there was very little that medicine could offer to protect, or restore, the brain function.In comparison with the orchestrated full-front industry-sponsored research aimed at supporting the failing heart, only a few research centers remained interested in the brain. …