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Cardiac Arrest
The Science and Practice of
Resuscitation Medicine
Second edition
Cardiac Arrest is the definitive and most comprehensive
reference in advanced life support and resuscitation medi-
cine.
This new edition brings the reader completely up-to-
date with developments in the field, focusing on practical
issues of decision making, clinical management and pre-
vention, as well as providing clear explanations of the
science informing the practice. The coverage includes
information on the latest pharmacotherapeutic options,
the latest chest compression techniques and airway
management protocols, all backed by clearly explained,
evidence-based scientific research. The content is consis-
tent with the latest guidelines for practice in this area, as
detailed by the major international governing organiza-
tions.
This volume is essential reading for all those working in
the hospital environments of emergency medicine, critical
care, cardiology and anesthesia, as well as those providing
care in the pre-hospital setting, including paramedics and
other staff from the emergency services.
Norman A. Paradis is Adjunct Professor of Surgery,
University of Colorado Health Sciences Center.
Henry R. Halperin is Professor of Medicine, Radiology, and
Biomedical Engineering at the Johns Hopkins University
School of Medicine, Baltimore, USA.
Karl B. Kern is Professor of Medicine at the Sarver Heart
Center, University of Arizona, USA.
Volker Wenzel is Associate Professor of Anesthesiology
and Critical Care Medicine in the Department of
Anesthesiology and Critical Care Medicine of Innsbruck
Medical University, Innsbruck, Austria.
Douglas A. Chamberlain CBE is Honorary Professor of
Resuscitation Medicine at the School of Medicine, Cardiff
University, Wales and Visiting Professor of Cardiology at the
University of Brighton, Sussex, UK.
From reviews of the first edition:
. . . It is a tribute to the editors of this book, and the con-
tributors they have selected, that they have managed to
produce a book of enormous quality on the science of
resuscitation medicine. The Lancet
The excellent book, the first of its kind in the field of cardiac
arrest, provides a balance of theoretical and clinical infor-
mation. It achieves a level of authority and sophistication
well beyond that of the advanced cardiac life support
guidelines and will be of considerable use to all those prac-
ticing or teaching clinical resuscitation.
The New England Journal of Medicine
The book has virtually everything one would ever want to
know about the causes of cardiac arrest, the applied phys-
iology, and its treatment. Physicians and nurses involved in
the management of critically ill or injured patients should
have Cardiac Arrest in their personal libraries for ready ref-
erence. Resuscitation
Cardiac Arrest
The Science and Practice of
Resuscitation Medicine
Second edition
Editors
Norman A. Paradis, M.D.
University of Colorado, Denver, USA
Henry R. Halperin, M.D., M.A.
Johns Hopkins University School of Medicine, Baltimore, MD, USA
Karl B. Kern, M.D.
University of Arizona, Sarver Heart Center, Tucson, AZ, USA
Volker Wenzel, M.D., M.Sc.
Innsbruck Medical University, Innsbruck, Austria
Douglas A. Chamberlain CBE, M.D.
School of Medicine, Cardiff University, Wales, UK
Senior Associate Editor
Max Harry Weil, M.D.
Weil Institute of Critical Care Medicine, Rancho Mirage, CA, USA
Associate Editors
Scott M. Eleff, M.D.
William Beaumont Hospital, Royal Oak, MI, USA
Terry L.Vanden Hoek, M.D.
University of Chicago, IL, USA
Vinay M. Nadkarni, M.D.
Children’s Hospital of Philadelphia, PA, USA
Development Editor
Pamela Talalay, Ph.D.
Johns Hopkins University School of Medicine, Baltimore, MD, USA
CAMBRIDGE UNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo
Cambridge University Press
The Edinburgh Building, Cambridge CB2 8RU, UK
Published in the United States of America by Cambridge University Press, New York
www.cambridge.org
Information on this title: www.cambridge.org/9780521847001
© Norman A. Paradis, Henry R. Halperin, Karl B. Kern, Volker Wenzel and Douglas A.
Chamberlain 2007
This publication is in copyright. Subject to statutory exception and to the provision of
relevant collective licensing agreements, no reproduction of any part may take place
without the written permission of Cambridge University Press.
First published in print format 2007
ISBN-13 978-0-511-35489-2 eBook (EBL)
ISBN-10 0-511-35489-4 eBook (EBL)
ISBN-13 978-0-521-84700-1 hardback
ISBN-10 0-521-84700-1 hardback
Cambridge University Press has no responsibility for the persistence or accuracy of urls
for external or third-party internet websites referred to in this publication, and does not
guarantee that any content on such websites is, or will remain, accurate or appropriate.
Every effort has been made in preparing this publication to provide accurate and up-to-
date information which is in accord with accepted standards and practice at the time of
publication. Although case histories are drawn from actual cases, every effort has been
made to disguise the identities of the individuals involved. Nevertheless, the authors,
editors and publishers can make no warranties that the information contained herein is
totally free from error, not least because clinical standards are constantly changing through
research and regulation. The authors, editors and publishers therefore disclaim all liability
for direct or consequential damages resulting from the use of material contained in this
publication. Readers are strongly advised to pay careful attention to information provided
by the manufacturer of any drugs or equipment that they plan to use.
In memory of Harold Paradis, M.D., without whose
inspiration this effort would never have been under-
taken, and for Christine, without whose patience it
would never have been completed. N.A.P.
To my wife, Sharon Tusa Halperin, and children,
Victoria and Eric Halperin, whose patience and
support inspired me to complete my contributions to
this work. In memory of Victor Halperin, D.D.S., who
inspired me to undertake a career in academic med-
icine and complete this work. H.R.H.
To Martha, my wife, who always understood that the
most worthwhile books are written with friends, and
that true friendship develops best while fly fishing,
and to Matt, my youngest son, who has helped me
keep my perspective that each day is wonderful and
full of promise. K.B.K.
To my daughter Katharina, whose love from
Innsbruck to the moon and back keeps me going on
good days and especially on bad days, and in
memory of Gunther and Ute Wenzel. And to my
friends worldwide providing ideas, critique, encour-
agement, and hard work. V.W.
To my wife Jennifer, who continues to be incredibly
tolerant of a husband who is forever ensconsed in
his study and who offers no help with the washing
up. D.A.C.
Contents
List of contributors xi
Foreword – Myron L. Weisfeldt M.D. xxvii
Preface xxxi
Part I Introduction
1 A history of cardiopulmonary resuscitation 3
Mickey S. Eisenberg, Peter Baskett, and Douglas
Chamberlain
2 The epidemiology of sudden death 26
Graham Nichol and David Baker
Part II Basic science
3 Global cellular ischemia/reperfusion during
cardiac arrest: critical stress responses and the
postresuscitation syndrome 51
Kimm Hamann, Dave Beiser, and Terry L. Vanden Hoek
4 Genetics, genomics and proteomics in sudden
cardiac death 70
Lesley A. Kane, Silvia G. Priori, Carlo Napolitano, Dan E.
Arking, and Jennifer E. Van Eyk
5 Intracellular signaling during myocardial
ischemia 90
Peter H. Sugden
6 Electrophysiology of ventricular fibrillation and
defibrillation 101
Wei Xiong and Gordon F. Tomaselli
7 The neuroendocrine response to global ischemia
and reperfusion 128
Martin W. Dünser, Stefan Jochberger, Karl-Heinz
Stadlbauer, and Volker Wenzel
vii
viii Contents
8 Inflammatory and Immunologic responses to 21 Analysis and predictive value of the ventricular
ischemia and reperfusion 163 fibrillation waveform 417
Jason S. Haukoos, Ronald J. Korthuis, and James T. Trygve Eftestøl, Hans-Ulrich Strohmenger, and Colin
Niemann Robertson
22 Etiology, electrophysiology, and myocardial
Resuscitation research
mechanics of pulseless electrical activity 426
9 Methodology of laboratory resuscitation research 179 Tom P. Aufderheide
Menekhem Zviman and Henry R. Halperin
10 The methodology of clinical resuscitation
Part IV Therapy of sudden death
research 206
Johan Herlitz, Anouk van Alem, Volker Wenzel, and Karl
23 Prevention of sudden cardiac death 449
Wegscheider
Catherine Campbell, Ty J. Gluckman, Charles Henrikson,
11 The special problem of consent for resuscitation Dominique M. Ashen, and Roger S. Blumenthal
research 216
24 Sequence of therapies during resuscitation:
Henry R. Halperin and Douglas Chamberlain
application of CPR 463
Leonard A. Cobb
Part III The pathophysiology of global ischemia 25 Transthoracic defibrillation 470
and reperfusion Richard E. Kerber, Charles D. Deakin, and
Willis A. Tacker, Jr.
12 The etiology of sudden death 229
26 Automated external defbrillators 482
Sunil K. Sinha, Arthur J. Moss, and Hugh G. Calkins
Rudolph W. Koster, Douglas Chamberlain, and Dianne L.
Atkins
13 Global brain ischemia and reperfusion 236
Brian J. O’Neil, Robert W. Neumar, Uwe Ebmeyer, and
27 Public access defibrillation 496
Gary S. Krause
Roger D. White, Mick Colquhoun, Carys Sian Davies, Mary
Ann Peberdy, and Sergio Timerman
14 Reperfusion injury in cardiac arrest and
cardiopulmonary resuscitation 282
28 The physiology of ventilation during cardiac
Thomas Aversano
arrest and other low blood flow states 506
Ahamed H. Idris and Andrea Gabrielli
15 Visceral organ ischemia and reperfusion in
cardiac arrest 298
29 Airway techniques and airway devices 550
Kevin R. Ward and Andreas W. Prengel
Jerry P. Nolan and David A. Gabbott
16 Mechanisms of forward flow during external
External chest compression: standard and
chest compression 326
alternative techniques
Henry R. Halperin
30 Manual cardiopulmonary resuscitation
Perfusion pressures
techniques 571
Henry R. Halperin and Barry K. Rayburn
17 Hemodynamics of cardiac arrest 347
Michael P. Frenneaux and Stig. Steen
31 Mechanical devices for cardiopulmonary
resuscitation 585
18 Coronary perfusion pressure during
Henry R. Halperin
cardiopulmonary resuscitation 369
Karl B. Kern, James T. Niemann, and Stig Steen
32 Invasive reperfusion techniques 600
Mark G. Angelos
19 Methods to improve cerebral blood flow and
neurological outcome after cardiac arrest 389
33 Routes of drug administration 614
Uwe Ebmeyer, Laurence M. Katz, and Alan D. Guerci
Thomas Kerz, Gideon Paret, and Holger Herff
20 Pharmacology of cardiac arrest and reperfusion 395
Tommaso Pellis, Jasmeet Soar, Gavin Perkins, and Raúl J.
Gazmuri
