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Background: Treatment after cardiac arrest has become more complex and interdisciplinary over the last few years. Thus, the clinically active intensive and emergency care physician not only has to carry out the immediate care and acute diagnostics, but also has to prognosticate the neurological outcome., Aim: The different, most important steps are presented by leading experts in the area, taking into account the interdisciplinarity and the currently valid guidelines., Materials and Methods: Attention was paid to a concise, practice-oriented presentation., Results and Discussion: The practical guide contains all important steps from the acute care to the neurological prognosis generation that are relevant for the clinically active intensive care physician.

Extracorporeal cardiopulmonary resuscitation (eCPR) may be considered as a rescue attempt for highly selected patients with refractory cardiac arrest and potentially reversible etiology. Currently there are no randomized, controlled studies on eCPR, and valid predictors of benefit and outcome which might guide the indication for eCPR are lacking. Currently selection criteria and procedures differ across hospitals and standardized algorithms are lacking. Based on expert opinion, the present consensus statement provides a proposal for a standardized treatment algorithm for eCPR.

Purpose of Review: Artificial ventilation is one of the best known resuscitation procedures. It is generally accepted that there must be oxygen delivery to vital organs during cardiac arrest and resuscitation in order to prevent irreversible damage, but there is an increasing number of ventilation concepts for resuscitation. Traditional and alternative methods of ventilation are reviewed., Recent Findings: The need for positive-pressure ventilation during resuscitation as an essential gold standard might be overestimated at least in the first minutes of cardiopulmonary resuscitation (CPR). The co-founders of the concept of cardiocerebral resuscitation could show positive effects of a sole passive oxygenation at the beginning of advanced life support (ALS). Research was published on continuous positive airway pressure (CPAP) ventilation as well as on CPAP plus pressure support ventilation. In addition to positive-pressure ventilation, the use of an impedance threshold device, partly in addition with active compression-decompression CPR, was investigated in both experimental and clinical settings. None of these methods alone could be proven to improve the outcome of cardiac arrest. The role of high oxygen concentration during CPR also remains unclear., Summary: Positive-pressure ventilation with pure oxygen remains, in clinical practice, the gold standard in ALS. Further research should focus on the role of passive oxygenation during early ALS. The concentration of oxygen needed during resuscitation has to be defined and alternative ventilation patterns, regarding the impact of CPR, should be investigated.

Daily routine procedures in anesthesia may be associated with critical events including cardiac arrest. Therefore every anesthesiologist must be informed completely about standards and guidelines for resuscitation to provide adequate patient safety. In October 18 (th), 2010, new international guidelines for resuscitation were published. The main changes in these resuscitation guidelines are described., (© Georg Thieme Verlag Stuttgart · New York.)

Background: During cardiac arrest the paramount goal of basic life support (BLS) is the oxygenation of vital organs. Current recommendations are to combine chest compressions with ventilation in a fixed ratio of 30:2; however the optimum compression/ventilation ratio is still debatable. In our study we compared four different compression/ventilation ratios and documented their effects on the return of spontaneous circulation (ROSC), gas exchange, cerebral tissue oxygenation and haemodynamics in a pig model., Methods: Study was performed on 32 pigs under general anaesthesia with endotracheal intubation. Arterial and central venous lines were inserted. For continuous cerebral tissue oxygenation a Licox PtiO(2) probe was implanted. After 3 min of cardiac arrest (ventricular fibrillation) animals were randomized to a compression/ventilation-ratio 30:2, 100:5, 100:2 or compressions-only. Subsequently 10 min BLS, Advanced Life Support (ALS) was performed (100%O(2), 3 defibrillations, 1mg adrenaline i.v.). Data were analyzed with 2-factorial ANOVA., Results: ROSC was achieved in 4/8 (30:2), 5/8 (100:5), 2/8 (100:2) and 0/8 (compr-only) pigs. During BLS, PaCO(2) increased to 55 mm Hg (30:2), 68 mm Hg (100:5; p=0.0001), 66 mm Hg (100:2; p=0.002) and 72 mm Hg (compr-only; p<0.0001). PaO(2) decreased to 58 mmg (30:2), 40 mm Hg (100:5; p=0.15), 43 mm Hg (100:2; p=0.04) and 26 mm Hg (compr-only; p<0.0001). PtiO(2) baseline values were 12.7, 12.0, 11.1 and 10.0 mm Hg and decreased to 8.1 mm Hg (30:2), 4.1 mm Hg (100:5; p=0.08), 4.3 mm Hg (100:2; p=0.04), and 4.5 mm Hg (compr-only; p=0.69)., Conclusions: During BLS, a compression/ventilation-ratio of 100:5 seems to be equivalent to 30:2, while ratios of 100:2 or compressions-only detoriate peripheral arterial oxygenation and reduce the chance for ROSC.

Objective: During basic life support (BLS) by a two-rescuer-team early defibrillation and ALS procedures should be performed without interruptions of the BLS-ventilation/compression sequence. The objective of this study was to determine the impact of a ventilation/compression ratio of 5:50 versus 2:15 on the time intervals "Start BLS to first shock" and "Start BLS to intubation"., Methods: Using a random cross over design 40 experienced paramedics performed a standard BLS/ALS-algorithm according to ILCOR guidelines in a manikin model with ventricular fibrillation (resusci skillreporter anne, Laerdal, Norway) performing both the 2:15 and the 5:50 ventilation/compression ratio. BLS was started with bag/valve/mask ventilation, a semi-automatic defibrillator (corpuls 08/16S) was connected with the manikin, ECG-analysis and three shocks were performed and the tracheal intubation was prepared. Ventilation/compression sequence was only interrupted during ECG-analysis and defibrillation. Expiratory volumes and number of compressions were measured. Variables were compared using paired Students t-test. In addition paramedics were interviewed about work-flow and emotional stress during the tests., Results: The time interval "Start BLS to first shock" was 78 s (2:15-group) versus 63 s (5:50-group), p<0.0001, the time interval "Start BLS to intubation" was 183 s (2:15-group) versus 150 s (5:50-group), p<0.0001, mean ventilation volumes per minute were 4490 ml (2:15-group) versus 4370 ml (5:50-group), p>0.1, mean number of compressions were 65 min-1. (2:15-group) versus 68 min-1 (5:50-group), p>0.1. The work-flow and emotional stress was appraised by the paramedics to be significantly superior in the 5:50 ratio (p<0.0001)., Conclusions: The ventilation/compression ratio of 5:50 compared with 2:15 during BLS with an unsecured airway reduces the time until the first defibrillation and tracheal intubation was performed without changes in ventilation volume and compressions per minute. The Paramedics stated that the 5:50 ratio improved the work-flow and reduced the emotional stress.