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  • Review Article
  • Published:

Cardiopulmonary resuscitation and management of cardiac arrest

Nature Reviews Cardiology volume 9, pages 499–511 (2012)Cite this article

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This article has been updated

Abstract

The best chance of survival with a good neurological outcome after cardiac arrest is afforded by early recognition and high-quality cardiopulmonary resuscitation (CPR), early defibrillation of ventricular fibrillation (VF), and subsequent care in a specialist center. Compression-only CPR should be used by responders who are unable or unwilling to perform mouth-to-mouth ventilations. After the first defibrillator shock, further rhythm checks and defibrillation attempts should be performed after 2 min of CPR. The underlying cause of cardiac arrest can be identified and treated during CPR. Drugs have a limited effect on long-term outcomes after cardiac arrest, although epinephrine improves the success of resuscitation, and amiodarone increases the success of defibrillation for refractory VF. Supraglottic airway devices are an alternative to tracheal intubation, which should be attempted only by skilled rescuers. Care after cardiac arrest includes controlled reoxygenation, therapeutic hypothermia for comatose survivors, percutaneous coronary intervention, circulatory support, and control of blood-glucose levels and seizures. Prognostication in comatose survivors of cardiac arrest needs a careful, multimodal approach using clinical and electrophysiological assessments after at least 72 h.

Key Points

  • Survival from cardiac arrest depends on a sequence of interventions: early recognition and call for help, early cardiopulmonary resuscitation (CPR), early defibrillation, and postarrest care

  • Survival to hospital discharge is approximately 15–20% and <10% after in-hospital or out-of-hospital cardiac arrest, respectively

  • Early bystander CPR doubles survival from cardiac arrest; interventions such as training, dispatcher-assisted CPR, and the use of compression-only CPR can increase the number of individuals who receive bystander CPR

  • High-quality CPR (adequate compression rate and depth, allowing recoil, and minimizing hands-off time) improves survival; feedback devices improve CPR quality, but did not increase patient survival in a cluster-randomized trial

  • Ventricular fibrillation should be treated with early defibrillation with minimal interruption to CPR; the role of drugs and the use of airway interventions during CPR require further study

  • The quality of care after successful resuscitation (including therapeutic hypothermia, percutaneous coronary intervention, and a multimodal approach to prognostication) is a major determinant of survival with good neurological outcome

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Figure 1: The development of CPR.
Figure 2: Interventions in the 'chain of survival'.1

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Change history

  • 27 June 2012

    In the version of this article initially published online, the sentence “A study of the ITD compared with a sham valve when used with conventional CPR showed no benefit with the ITD.62” on page 4 should have read “A study of the ITD compared with a sham valve when used with conventional CPR showed no benefit with the ITD.62” The error has been corrected for the print, HTML and PDF versions of the article.

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Acknowledgements

We thank Daniel Pehboeck, Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Austria, for assistance with Figure 1.

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Authors and Affiliations

  1. Anaesthesia and Intensive Care Medicine, Royal United Hospital, Combe Park, Bath, BA1 3NG, UK

    Jerry P. Nolan

  2. Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK

    Jasmeet Soar

  3. Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstraße 35, Innsbruck, 6020, Austria

    Volker Wenzel & Peter Paal

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All the authors contributed substantially to researching the data for the article, discussions of its content, and to writing, reviewing, and editing the manuscript before submission.

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Correspondence to Volker Wenzel.

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Competing interests

J. P. Nolan is a member of the European Resuscitation Council, the International Liaison Committee on Resuscitation, and the Resuscitation Council (UK). J. Soar is the Advanced Life Support Task Force co-chair for the International Liaison Committee on Resuscitation, and the chair of the Resuscitation Council (UK). The other authors declare no competing interests.

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The development of CPR* (DOC 97 kb)

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Nolan, J., Soar, J., Wenzel, V. et al. Cardiopulmonary resuscitation and management of cardiac arrest. Nat Rev Cardiol 9, 499–511 (2012). https://doi.org/10.1038/nrcardio.2012.78

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