Cardiocerebral resuscitation: a broader perspective.

Historically, cardiac arrest outcomes have been stagnant with few therapies demonstrating clinical benefit. Recent advances in our understanding of cardiac arrest physiology and therapy have led to improved outcomes and renewed interest in defining the "optimal" approach. Cardiocerebral resuscitation (CCR) represents a bundle of specific therapies designed to enhance perfusion during cardiopulmonary arrest by emphasizing chest compressions over ventilations and "priming" the heart with compressions before and after defibrillation attempts. Implemented in Arizona and Wisconsin in 2003, patients treated using CCR appear to have improved outcomes compared with those treated under the 2000 guidelines from the International Liaison Committee on Resuscitation (ILCOR). This was particularly true in the subgroup of patients with bystander-witnessed collapse, who may represent a group with adequate oxygen reserves at the time of arrest and decreased requirement for immediate positive-pressure ventilation. Many components of CCR have since been incorporated in the 2005 ILCOR guidelines. Beyond the specific treatment approaches that define CCR, this alternative approach may represent the future of resuscitation science in which each institution and emergency medical services agency will define an optimal approach to treatment and training based on the specific resources available and patient population. This may mandate a paradigm shift away from advanced cardiac life support and basic life support, which emphasize standardization of content and format rather than institution- or agency-specific protocols and training.