Cardiopulmonary Resuscitation

Preface

Wanchun Tang, MD, Master CCMGuest Editor

The current disappointing outcome of cardiopulmonary resuscitation after suddendeath reflects not only the constraints in implementation but also, in my opinion, thestill primitive knowledge of the pathophysiology of cardiac arrest and the implicationfor resuscitation. Surprisingly, there is a paucity of research and research support.Such a fact, in part, reflects the lack of incentive to support such research. Theperception of many, in both the professional and the lay communities, is that CPR isa “settled issue” that requires little or no additional research. Although the AmericanHeart Association has always cautioned in each of the Guidelines of CPR otherwise,this perception of a settled issue continues.

Like science more generally, medical science usually advances at an escalatingpace only when there is focus on unresolved challenges of large magnitudes. Thedisappointing statistics that have disclosed little or no improvement in outcome inthe more than 50 years since modern CPR was introduced notwithstanding, thescience has progressed but little in the absence of such a focus by the profession, bythe public, and by the government. To illustrate the potential benefits, an improve-ment in outcome of CPR from the current approximately 5% national survival rate toas little as 20% would rescue more than two times the number of annual fatalities fromautomobile accidents.

This issue of Critical Care Clinics presents some of the major advances in thescience of cardiopulmonary and cerebral resuscitation and is written by the interna-tionally recognized experts in the field. I would like to express my sincere appreciationto those experts who contributed so richly to this issue. The subjects of this issueliterally deal with life and death, death without warning, and death that occurs inout-of-hospital victims without terminal illnesses. It is very challenging to studyvictims under these conditions. The restraints are practical, ethical, and legal. In theabsence of secure data on patients, a large part of the current knowledge andpractices is based on experimental studies in animals. Although we appreciate thatthe guidelines of the American Heart Association may be the best reference tostandards of practice, these, nevertheless, represent consensus often without secureevidence based on controlled studies. I am confident, however, that it will be advances

Crit Care Clin 28 (2012) xi–xiiidoi:10.1016/j.ccc.2012.01.001 criticalcare.theclinics.com

0749-0704/12/$ – see front matter © 2012 Elsevier Inc. All rights reserved.

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in science and, specifically, better objective data on victims that will account for improvedoutcomes.

The individual viewpoints of the authors were in each instance respected. Accord-ingly, the content of this issue is not constrained by a peer consensus. I would,therefore, alert the reader that, in some instances, the content differs significantly andunderstandably from published American Heart Association guidelines.

Wanchun Tang, MD, Master CCMThe Weil Institute of Critical Care Medicine

35-100 Bob Hope DriveRancho Mirage, CA 92270, USA

E-mail address:drsheart@aol.com

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Dedication

To the research team of the Weil Institute of Critical Care Medicine.