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A mechanical cardiopulmonary resuscitator is described. Its use in cardiac arrest is discussed and the machine is shown to be safe, simple to operate, and more efficient than manual techniques, both in the hospital and in the ambulance services.

The results of attempted resuscitation of 561 patients with cardiac or respiratory arrest are reported. A one-way speech, multiple-call system, and two mobile resuscitation trolleys were used. Most of the patients were between 50 and 80 years of age. Threequarters of the patients presented with cardiac arrest which manifested as asystole almost twice as often as ventricular fibrillation. The commonest causes of arrest were acute myocardial infarction, unknown causes, cardiac failure, recent surgery, and respiratory arrest. Autopsies were obtained in one-third of patients who died. Most calls were between 10.00 hours and 22.00 hours and came from the medical wards. The initial method of assisted ventilation was by endotracheal tube and Ambu-bag in almost one-half of the patients, face mask and Ambu-bag in one-quarter and mouth-to-mouth or mouthto-nose in only one-tenth. A spontaneous electrocardiogram and/or pulse was restored in approximately one-third of patients, spontaneous breathing in 22%, and consciousness in 9%, and 18% returned to their pre-arrest status. Successful resuscitation was achieved in 25% but only 8% survived to leave hospital. Patients with respiratory arrest fared more than twice as well as those with cardiac arrest.The factors relating to successful resuscitation are discussed.

Between 1965 and 1972, 126 patients with eclampsia were treated with the help of anaesthetists and reanimatologists. The patients were divided into five groups: 53 of them developed eclampsia during pregnancy or labour, and were treated with halothane and nitrous oxide anaesthesia, as well as Viadril G (10 mg/kg weight); they all recovered. A second group of 14 patients developed eclampsia in the puerperium. In addition to the treatment given to the first group, they were given diuretics, intravenous infusions and cortisol; all of them also recovered. A third group of 15 patients also had massive haemorrhages due to detachment of the placenta or atonic uterus; they required intravenous blood, vasodilators and intermittent positive pressure ventilation for several days; of these patients seven survived and eight died. The fourth group of 30 patients had acute respiratory insufficiency and eclamptic coma; their treatment was similar to that of the previous group but was carried out in the intensive care unit; they recovered consciousness in 2–3 days, but were liable to fits and hypertension for 5–7 days; 22 of them recovered and eight died. The fifth group of 14 deeply comatose women were dying when the resuscitation team arrived. They all succumbed; on post mortem, renal and hepatic necrosis and multiple cerebral petechial haemorrhages were found.

In training schedules for cardiopulmonary resuscitation (CPR) by one operator there are still differences in recommendations for the working rates and ratios between cardiac compressions and insufflations. In an attempt to reach a general agreement on CPR procedures experimental investigations have been done. These showed that the most favourable recommended schedule is a CPR employing ventilation and sternal compressions in a ratio of 2:15, with working rates of 80/min for compressions and 30/min for ventilation. If two operators are vailable for CPR, a compression rate of 60/min is recommended with one insufflation being interposed after each five compressions, without interfering with the rhythm of sternal compressions. The advantages for research, and as a training aid, of the new Ambu Simulator are discussed.

The paper reviews the experimental work which has led to the techniques of resuscitation in use today. Methods of artificial ventilation have changed from those involving chest compression to those employing positive pressure inflation of the lungs from expired air or mechanical means. The evidence is examined that positive pressure inflation is deleterious to the circulation, and also the possibility that some methods of artifical ventilation can induce a circulation of blood. The experimental basis of cardiac resuscitation is reviewed. Evidence is given of the effectiveness of external cardiac massage in producing a circulation of blood, and a review is made of the use of electric shock to defibrillate the heart. The role of drugs in cardiac resuscitation is also reviewed. The little-used technique of centripetal arterial blood transfusion is examined as an example of the difficulties facing resuscitation research in applying laboratory findings to the clinical situation.

Rats were anaesthetized and cooled to cardiac arrest. After 30 min in cardiac arrest, they were rewarmed with artificial respiration. The natural history of cooling and resuscitation was observed, and reversible cardiac arrest was compared with death. The rats had a hind-limb paralysis which recovered apparently completely in about 12 weeks. They also had a permanent weight loss relative to controls. The offspring of the cooled recovered rats were approximately the same number and weights as offspring of their litter-mates, but they grew more slowly. The rats which recovered had a prolonged deficit of vision and hearing.