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									                                                                                                            By Angelo Salvucci, Jr., MD, FACEP

CARDIOCEREBRAL RESUSCITATION                                             intact survival from 15% to 39% in patients with witnessed cardiac
   Ewy GA, Kern KB. Recent advances in cardiopulmonary                   arrests from shockable rhythms. Bobrow, et al (JAMA 299:1,158,
resuscitation: Cardiocerebral resuscitation. J Am Coll Cardiol           2008), saw survival increase from 5% to 18%.
53(2):149–57, Jan 13, 2009.                                                Many questions still need to be answered, though. First,
   Cardiocerebral resuscitation (CCR) is a new approach for resus-       although CCR seems to result in better outcomes than the 2000
citation of patients with cardiac arrest. It is composed of three        guidelines, we don’t know if it’s better than the 2005 guidelines,
components: 1) continuous chest compressions for bystander               which incorporated many of the changes found in CCR. Second,
resuscitation; 2) a new emergency medical services algorithm;            epinephrine is advised in CCR but not proven to be beneficial.
and 3) aggressive post-resuscitation care. The CCR method                And third, we do not know how well CCR works for non-shockable
has been shown to dramatically improve survival in the subset            rhythms, or for cardiac arrest from non-cardiac causes.
of patients most likely to survive cardiac arrest: those with wit-
nessed arrests and shockable rhythms on arrival of EMS.                  DEFIB THREAT TO BYSTANDERS
   The CCR method advocates continuous chest compressions                   Hoke RS, Heinroth K, Trappe HJ, Werdan K. Is external defibrilla-
without mouth-to-mouth ventilations for witnessed cardiac arrest.        tion an electric threat for bystanders? Resuscitation 2009
It advocates either prompt or delayed defibrillation, based on              Safety precautions during defibrillation and cardioversion are
the three-phase time-sensitive model of ventricular fibrillation         taken very seriously. The actual hazard for bystanders and rescu-
(VF) articulated by Drs. Myron Weisfeldt and Lance Becker. For           ers, however, has rarely been investigated. Recently, continuing
bystanders with access to AEDs and EMS personnel who arrive              chest compressions during defibrillation has been suggested
during the electrical phase (i.e., the first 4–5 mins. of VF arrest),    to improve outcome from cardiac arrest. This article is to review
the delivery of a prompt defibrillator shock is recommended.             reports on electric shocks to persons other than patients and to
However, EMS personnel most often arrive after the electrical            discuss the pertinent biomedical principles.
phase—in the circulatory phase of VF arrest. During the circulatory         Methods—Systematic search in medical literature databases
phase of VF arrest, the fibrillating myocardium has used up much         and consecutive hand-search of reference lists.
of its energy stores, and chest compressions that perfuse the               Results—A total of 29 adverse events are reported in the medical
heart are mandatory prior to and immediately after a defibrillator       literature: seven due to accidental or intentional defibrillator misuse,
shock. Endotracheal intubation is delayed, excessive ventilations        three due to device malfunction, four during training/maintenance
are avoided, and early-administration epinephrine is advocated.          procedures, and 15 during regular resuscitation efforts. Tingling sen-
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