Recent advances in cardiopulmonary resuscitation.

Reversal of cardiac arrest is contingent on rapid and effective restoration of myocardial blood flow. Thirty years have elapsed since closed-chest cardiopulmonary resuscitation (CPR) was introduced in clinical practice. Because of its technical simplicity and noninvasiveness, CPR was rapidly implemented and almost universally utilized for cardiac resuscitation. However, there is increasing concern about its value for cardiac resuscitation since the limited hemodynamic efficacy of precordial compression accounts for a disappointingly low success rate. More invasive interventions by which blood flow is restored such as open-chest cardiac massage or extracorporeal circulation are consistently more effective than conventional CPR. Experimentally, both methods restore systemic and myocardial perfusion to viable levels and thereby increase the likelihood of restoring spontaneous circulation even after prolonged cardiac arrest or failure of conventional CPR.