A CHAQUE EPOQUE, SA TECHNIQUE DA REANIMATION: Past, present and future

OBJECTIVE: To review the major changes and advances in cardiopulmonary resuscitation (CPR) since its first description over 100 years ago. DATA SOURCES: A MEDLINE search of the English literature (1966 to 1994) was done using the keywords 'cardiopulmonary resuscitation', 'CPR', 'heart massage', 'techniques' and 'methods'. STUDY SELECTION: Articles were selected based on content related to promising CPR techniques and specifically on alternate methods of closed chest compression. DATA EXTRACTION: Performed independently by the authors. DATA SYNTHESIS: Over the past three and a half decades, the importance of rapid institution of CPR has become increasingly recognized. This has led to a strenuous effort to educate the public in CPR delivery in addition to making definitive treatment with emergency medical systems more readily accessible. Furthermore, as the physiology of closed chest massage has become better understood, investigators have been able to focus their efforts appropriately to exploit the mechanisms that are operative during CPR. As a result, several modifications have been proposed in adjuvant therapies administered concomitantly with CPR, as well as in new, innovative methods of CPR delivery. Many of these changes and new methods show promise for improving vital organ perfusion and patient survival. CONCLUSIONS: CPR has become increasingly recognized as an important element in the chain of survival for victims of cardiopulmonary arrest. Several advances in delivery and technique have resulted in improved resuscitation of cardiopulmonary arrest victims. However, despite these advances, additional research is needed to improve further the still dismal overall survival of victims of cardiopulmonary arrest.