Cardiopulmonary Resuscitation (CPR)




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Minimally Interrupted Cardiac Resuscitation (MICR) (Cardiocerebral Resuscitation)

  • History: protocol was developed at the University of Arizona Sarver Heart Center and was first instituted in Tucson, Arizona, in late 2003
  • Rationale: protocol focuses on maximizing myocardial and cerebral perfusion via various features
    • Minimization of Interruption of Chest Compressions
    • Provision of Immediate Preshock Chest Compressions for Prolonged Ventricular Fibrillation (VF)
    • Delay/Elimination in Endotracheal Intubation
    • Minimization of Positive Pressure Ventilation
    • Decrease in the Time Interval to Intravenous Epinephrine Administration
  • Clinical Efficacy
    • Study of Minimally Interrupted Cardiac Resuscitation (MICR) by Emergency Services Personnel in Out-of-Hospital Cardiac Arrest (JAMA, 2008) [MEDLINE]: MICR improved survival to hospital discharge

Family Presence During Cardiopulmonary Resuscitation

  • French Study of Allowing Families to Witness Resuscitation (2013) [MEDLINE]: n = 570; relatives were allowed the option to witness CPR
    • Post-traumatic stress disorder (PTSD) was lower in the group who witnessed CPR (odds ratio: 1.7)
    • Symptoms of anxiety/depression were lower in the group who witnessed CPR
    • Witnessing CPR had no adverse effects on patient survival, health care team mental stress, or medicolegal proceedings
    • Cautions of study: study included a designated support assistant who carefully explained the CPR efforts to the family member


  • Increased Dead Space Ventilation with Acute Hypoventilation/Ventilatory Failure (see Acute Hypoventilation, [[Acute Hypoventilation]])
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Adverse Effects of Cardiopulmonary Resuscitation

Cardiovascular Adverse Effects

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Pulmonary Adverse Effects

Rheumatologic/Orthopedic Adverse Effects

  • Rib Fracture

Other Adverse Effects

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  • Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest. JAMA. 2008 Mar 12;299(10):1158-65. doi: 10.1001/jama.299.10.1158 [MEDLINE]
  • Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA. 2010 Oct 6;304(13):1447-54. doi: 10.1001/jama.2010.1392 [MEDLINE]
  • Active chest compression-decompression for cardiopulmonary resuscitation. Cochrane Database Syst Rev 2013 Sep 20;9:CD002751 [MEDLINE]

  • Family presence during cardiopulmonary resuscitation. N Engl J Med 2013;368(11):1008-1018 [MEDLINE]

  • Weighing the benefits and burdens of witnessed resuscitation. N Engl J Med 2013;368(11):1058-1059 [MEDLINE]

  • Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitations in out-of-hospital cardiac arrest. The LINC randomized trial. JAMA. 2014 Jan 1;311(1):53-61. doi: 10.1001/jama.2013.282538 [MEDLINE]