Introduction

Prehospital treatment of cardiac arrest became practical in 1960 when the technique of closed chest cardiac massage was demonstrated effectively to prolong the time for successful defibrillation following cessation of circulation due to cardiac arrest. Closed chest massage was merged with externally applied defibrillation and mouth-to-mouth ventilation to form what is today known as cardiopulmonary resuscitation or CPR. By 1966 standardized training and performance criteria had been developed and published. A few years later the American Heart Association (AHA) adopted CPR and spearheaded the campaign to disseminate it to both professionals and the public. The AHA periodically reviews the science, practice and implementation of CPR and publishes updated “guidelines.”

As an organizational model, CPR can be considered an outstanding public health achievement; but its success in this realm is marred by its failure as a treatment modality for patients who sustain an out-of-hospital cardiac arrest (OOH-CA). When the currently recommended guidelinedriven CPR is used to treat patients with an OOH-CA, survival rates have been and continue to be dismal. These poor and unchanged survival rates, in spite of periodic updates, may in part be explained because CPR was conceived as and is currently promulgated as an appropriate intervention for what turns out to be two pathophysiologically entirely different disorders: respiratory arrest and cardiac arrest.

A new approach to the resuscitation of individuals with out-of-hospital cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia was developed by the University of Arizona Sarver Heart Center CPR Research Group in Tucson, Arizona.