At least 350 000 people will suffer cardiac arrest each year in
the United States, 1 every 90 seconds. Many will then
undergo cardiopulmonary resuscitation (CPR) by bystanders and
emergency medical services in a desperate attempt to restore life.
Numerous studies report that the majority of these efforts will
not succeed. Prolonged anoxia, the inability to restore spontaneous
circulation, neurological devastation, and other complications
combine to limit survival. Nonetheless, thousands will
surmount these obstacles and resume normal lives. CPR is a
triumph of medicine but also is frequently performed in vain. It
is a young science; the term “CPR” was first publicized less than
50 years ago. The roots of resuscitation, however, extend back
centuries, with a gradual course of evolution that has been
periodically impeded by rejection of inadequate techniques,
curiously slow adoption of proven interventions, and even a
cyclic process of abandonment and subsequent rediscovery.
Examining the history of resuscitation is an essential first step to
understanding and following the evolution to modern practices.
A detailed review of more current observations, inventions, and
clinical trials, in the context of the disappointing statistics of
conventional CPR, will elucidate the rationale behind the most
recently published resuscitation guidelines, as well as provide
fuel for future research. Although components of life support
apply to the predominantly asphyxia-related arrests seen in
pediatrics, the focus of this review is on resuscitation after
cardiopulmonary arrest in the adult.