Three Phases of Cardiac Arrest Due to

“Why is it that every time I press on his chest he opens his eyes, and every time I stop to breathe for him he goes back to sleep?”1 This article reviews research that shows that cardiopulmo-nary resuscitation (CPR) as it has been practiced and as it is presently taught and advocated is far from optimal. The International Guidelines 2000 for Cardiopulmonary Resus-citation and Emergency Cardiovascular Care, hereafter re-ferred to as “Guidelines 2000, ” were evidence based.2 During their formulation, the greatest weight of evidence was given to placebo-controlled randomized trials in humans. Unfortu-nately, it is extremely difficult not only to obtain informed consent but also to obtain funding for studies of the magni-tude necessary to answer critically important CPR questions. It is unfortunate that controlled CPR research in animals was given the lowest priority in the evidence-based scheme.2 In our opinion, controlled animal experiments provide data that may be nearly impossible to obtain in human trials in which the circumstance, age, disease states, interventions, and re-sponse times to arrest are variable and often unknown. On the other hand, the use of swine for CPR research is not the perfect experimental solution, because they are easier to resuscitate in that they have no underlying heart disease (unless experimentally produced), they are younger, and they have more compliant chests than older adults with cardiac arrest. Since the formulation of “Guidelines 2000, ” old and new research in animals and new research in humans have rendered them outdated. Although they will be revised, it is unknown when and what changes will be made. Nevertheless, in 2003, the CPR research information from both animal and humans was so compelling that we could not in good conscience wait for yet another set of new guidelines. Accordingly, our CPR research group, in cooperation wit