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Cardiovascular disease remains the leading cause of death in the United States.1,2 Acute myocardial infarctions associated with ischemic heart disease accounts for the majority of sudden deaths.3


Sudden cardiac death is the unexpected, nontraumatic, abrupt cessation of effective cardiac function associated with absent or acute symptoms of less than 1 hour.4,5 Prodromes such as chest pain, palpitations, or fatigue may occur within the preceding 24 hours.4 The majority of deaths occur within 2 hours of the onset of symptoms.1,2,6–8 Most victims die before reaching a hospital.1,2


Cardiopulmonary resuscitation (CPR) describes the emergency measures used to restore cardiovascular and respiratory function. Notably, cardiocerebral resuscitation represents preferable terminology as it conveys more appropriate emphasis on neurologic recovery. Clinical interventions have been formulated as Advanced Cardiac Life Support (ACLS) guidelines9 based on scientific data established by the American Heart Association (AHA) and International Liaison Committee on Resuscitation.10


CPR and/or ACLS are performed in 1 to 2% of patients admitted to teaching hospitals (including approximately 30% of patients who die).11,12 The goals are to restore spontaneous circulation (ROSC), and ultimately, survive. Early defibrillation is the single most effective means for ROSC. Otherwise, ROSC depends on improving myocardial perfusion and treating underlying disorders. Mechanical circulatory support devices and therapeutic hypothermia represent treatment interventions that may improve these life-saving endeavors. Overall survival rates remain low (Table 17-1), and successful resuscitation frequently results in neurologic impairment.13–15,129 The clinical integration of rapid response, early defibrillation, circulatory support devices, hypothermia, and neuroprotective agents should improve future outcomes.

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Table 17-1 Published Reports of Clinical Outcomes after Cardiac Arrest

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