Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-22T21:19:15.605Z Has data issue: false hasContentIssue false
  • English
  • Français

Pneumothorax During CPR Training: Case Report and Review of the CPR Literature

Published online by Cambridge University Press:  28 June 2012

Francis Sullivan  and
Daniel Avstreih
Francis Sullivan*
Affiliation:
Clinical Associate Professor of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA
Daniel Avstreih
Affiliation:
Brown University School of Medicine, Providence, Rhode Island, USA
*
*Clinical Associate Professor of Medicine, Brown University School of Medicine, 593 Eddy Street, Providence, Rhode Island 02903, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Cardiopulmonary resuscitation is taught widely to both lay persons and health care oworkers. It is a challenging psychomotor skill. Concerns about its safety to the rescuer have centered around the risk of infectious disease exposure. A young nursing assistant developed a minimally symptomatic pneumothorax during CPR training. This case is the first reported example of this complication for a CPR trainee or provider. The literature is reviewed for complications for CPR provider and recipient and the relevant issues regarding the current status and future direction of this intervention.

Keywords

cardiopulmonary resuscitationcomplicationseconomicsmethodspneumothoraxpsychologystandardstrainingtrends
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 15 , Issue 1 , March 2000 , pp. 72 - 77
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Simoneaux, SF, Murphy, BJ, Tehranzadeh, J: Spontaneous pneumothorax in a weight lifter. American Journal of Sports Medicine 1990;18(6):647–648.Google Scholar
2.Askins, DC: Spontaneous tension pneumothorax during sexual intercourse. Ann Emerg Med 1984;13(4):303–306.Google Scholar
3.Wait, MA, Estrera, A: Changing clinical spectrum of spontaneous pneumothorax. Am J Surg 1992;164:528–531.CrossRefGoogle ScholarPubMed
4.Melton, LJ, Hepper, NGG, Offord, KP: Influence of height on the risk of spontaneous pneumothorax. Mayo Clin Proc 1981;56:678–682.Google ScholarPubMed
5.Gawkrodger, DJ: Marfan's syndrome presenting as bilateral spontaneous pneumothorax. Postgrad Med 1981;57:240–241.CrossRefGoogle ScholarPubMed
6.Snell, NJC: Mitral valve prolapse, spontaneous pneumothorax, and abnormal lung collagen. Chest 1987;9(5):793–794.CrossRefGoogle Scholar
7.Vukich, DJ: Diseases of the pleural space. Emerg Med Clin N Amer 1989;7(20):309–324.CrossRefGoogle ScholarPubMed
8.Memon, AM, Salzer, JE, Hilman, EC, et al: Fatal myocardial infarct following CPR training: The question of risk. Ann Emerg Med 1982;11(6):322–323.Google Scholar
9.Salzer, JE, Marshall, CL, Hillman, E, et al: CPR: A report of observed medical complications during training. Ann Emerg Med 1983;12(3):194–195.Google Scholar
10.Lonergan, JH, Youngberg, JZ, Kaplan, JA: Cardiopulmonary resuscitation: Physical stress on the rescuer. Crit Care Med 1981;9(11):793–795.CrossRefGoogle ScholarPubMed
11.Baubin, M, Schirmer, M, Nogler, M, et al: Rescuer's work capacity and duration of cardiopulmonary resuscitation. Resuscitation 1996;33(2):135–139.Google Scholar
12.Emergency Cardiac Care Committee, Heart and Stroke Foundation of Canada: Disease transmission and cardiopulmonary resuscitation. Can Med Assoc J 1990;143(10):1007–100.Google Scholar
13.Glaser, JB, Nadler, JP: Hepatitis B virus in a cardiopulmonary resuscitation training course: Risk of transmission from a surface antigen — positive participant. Arco Intern Med 1985;145:1653–1655.CrossRefGoogle Scholar
14.Clinical Briefs: HIV seroprevalence in cardiac arrest patients. Am Fam Phys 1992;46(4):1312.Google Scholar
15.Michael, AD, Forrester, JS: Mouth-to-mouth ventilation: The dying art. Am J Emerg Med 1992;10(2):156–161.Google Scholar
16.Ornato, JP, Hallagan, LF, McMahan, , et al: Attitudes of BCLS instructors about mouth-to-mouth resuscitation during the AIDS epidemic. Ann Emerg Med 1990;19:151–156.CrossRefGoogle ScholarPubMed
17.Flint, LS, Billi, JE, Kelly, K, et al: Education in adult basic life support training programs. Ann Emerg Med 1993;22(Part 2):468–474.CrossRefGoogle ScholarPubMed
18.Cohen, HJ, Minkin, W: Transmission of infection during training for cardiopulmonary resuscitation. Ann Intern Medicine 1985;102(1):136.Google Scholar
19.Saviteer, SM, White, GC, Cohen, MS, et al: HTLV III exposure during cardiopulmonary resuscitation. N Engl J Med 985;313(25):1606–1607.Google Scholar
20.Achong, MR: Infectious hazards of mouth-to-mouth resuscitation. Am Heart J 1980;100(5):759–780.Google Scholar
21.Emergency Cardiac Care Committee of the American Heart Association: Risk of infection during CPR training and rescue: Supplemental guidelines. JAMA 1989;262(19):2714–2715.CrossRefGoogle Scholar
22.Corless, IB, Lasker, A, Buckheit, RW: Decontamination of an HIV-contaminated CPR manikin. Am J Pub Health 1992;82(11):1542–1543.Google Scholar
23.Brenner, B, Kauffman, J, Sachter, JJ. Comparison of the reluctance of house staff of metropolitan and suburban hospitals to perform mouth-to-mouth resuscitation. Resuscitation 1996;32(1):5–12.CrossRefGoogle ScholarPubMed
24.Brenner, BE, Van, DC, Cheng, D, et al: Determinants of reluctance to perform CPR among residents and applicants: The impact of experience on helping behavior. Resuscitation 1997;35:203–211.CrossRefGoogle ScholarPubMed
25.Varon, J, Marik, PE, Fromm, RE. Cardiopulmonary resuscitation: A review for clinicians. Resuscitation 1998;36:133–145.CrossRefGoogle ScholarPubMed
26.Ahmed, F, Senidhira, DCA, Charters, J, et al: Transmission of salmonella by mouth-to-mouth resuscitation. Lancet 1990;335:787–788.Google Scholar
27.Todd, MA, Bell, JS: Shigellosis from cardiopulmonary resuscitation. JAMA 1980;243(4):331.CrossRefGoogle ScholarPubMed
28.Valenzuela, TD, Hooton, TM, Kaplan, EL, et al: Transmission of “toxic strep” syndrome from an infected child to a firefighter during CPR. Ann Emerg Med 1991;201:90–92.CrossRefGoogle Scholar
29.Figura, N: Mouth-to-mouth resuscitation and Helicobacter pylori infection. Lancet 1996;347:1342.Google Scholar
30.Hightower, D, Thomas, SH, Stone, CK, et al: Decay in quality of closed-chest compressions over time. Ann Emerg Med 1995;26:300–303.Google Scholar
31.Axelsson, A, Herlitz, H, Ekstrom, L, et al: Bystander-initiated cardiopulmonary resuscitation out-of-hospital. A first description of the bystanders and their experiences. Resuscitation 1996;33:3–11.Google Scholar
32.Swanson, RW: Psychological issues in CPR. Ann Emerg Med 1993;22(2Pt 2):350–353.Google Scholar
33.Axelsson, A, Herlitz, J, Karlsson, T, et al: Factors surrounding cardiopulmonary resuscitation influencing bystanders psychological reactions. Resuscitation 1998;37(1):13–20.Google Scholar
34.Bush, CM, Jones, JS, Cohle, SD, et al: Pediatrie injuries from cardiopulmonary resuscitation. Ann Emerg Med 1996;28:40–44.CrossRefGoogle Scholar
35.Sommers, MS: Potential for injury: Trauma after cardiopulmonary resuscitation. Heart Lung 1991;20:287–295.Google Scholar
36.Powner, DJ, Holcombe, PA, Mello, LA: Cardiopulmonary resuscitation-related injuries. Crit Care Med 1984;12:54–55.CrossRefGoogle ScholarPubMed
37.Nagel, EL, Fine, EG, Krischer, JP, et al: Complications of CPR. Crit Care Med; 1981;9:454.Google Scholar
38.Clark, DT: Complications following closed-chest cardiac massage. JAMA 1962;181(4)337–338.Google Scholar
39.Jones, J, Fletter, B: Complications after cardiopulmonary resuscitation. Am J Emerg Med 1994;12(6)687–688.CrossRefGoogle ScholarPubMed
40.Enarson, DA, Didier, EP, Gracey, DR: Flail chest as a complication of cardiopulmonary resuscitation. Heart Lung 1977;6:1020–1022.Google Scholar
41.Kam, AC, Kam, PC: Scapular and proximal humeral head fractures. An unusual complication of cardiopulmonary resuscitation. Anesthesia 1994;49(12):1055–1057.Google Scholar
42.Nelson, BK: Tension pneumothorax following CPR or mechanical ventilation. Ann Emerg Med 1985;14(6):615.Google Scholar
43.Hillman, K, Albin, M: Pulmonary barotrauma during cardiopulmonary resuscitation. Crit Care Med 1986;14(7):606–609.Google Scholar
44.Shulman, D, Benzion, B, Olshwang, D: Pulmonary barotrauma during cardipulmonary resuscitation. Resuscitation 1987;15:201–207.CrossRefGoogle Scholar
45.Parke, TRJ: Unexplained pneumoperitoneum in association with basic cardiopulmonary resuscitation efforts. Resuscitation 1993;26:177–181.Google Scholar
46.Menzies, D, Noble, JG, Dent, CM, et al: Pneumoscrotum — An unusual complication of cardiopulmonary resuscitation. Brit J Urology 1991;67(4):440–441.Google Scholar
47.Mensah, GA, Gold, JP, Schreiber, T, et al: Acute purulent mediastinitis and sternal osteomyelitis after closed chest cardiopulmonary resuscitation: A case report and review of the literature. Ann Thoracic Surg 1988;46:353–355.Google Scholar
48.Wehrens, XHT, Doevendans, PA, van Dantzig, JM, et al: Infected sternal fracture hematoma after cardiopulmonary resuscitation initially seen as pericarditis. Am Heart J 1996;132:685–686.Google Scholar
49.Liu, N, Boyle, K, Bertrand, C, et al: Stomach rupture during CPR. Ann Emerg Med 1996;27(1):105–106.Google Scholar
50.Register, SD, Downs, JB, Tabeling, BB: Gastric mucosal lacerations: A complication of cardiopulmonary resuscitation. Anesthesiology 1985;62:513–514.Google Scholar
51.Norfleet, RG, Smith, GH: Mallory-Weiss syndrome after cardiopulmonary resuscitation. Clin Gastroenterol 1998;12(5):569–572.Google Scholar
52.Oh, CM, Hewitt, PM: Gastric rupture due to cardiopulmonary resuscitation. Injury 1998;29(5):399–400.CrossRefGoogle ScholarPubMed
53.Strear, CM, Jaragin, WR, Schecter, W, et al: Gastric rupture and tension pneumoperitoneum complicating cardiopulmonary resuscitation: Case report. J Trauma, Injury, Infection, and Critical Care 1998;44(5):930–932.Google Scholar
54.Reiger, J, Eritscher, C, Laubreiter, K, et al: Gastric rupture — An unusual complication after successful cardiopulmonary resuscitation: Report of two cases. Resuscitation 1997;35:175–178.Google Scholar
55.Stallard, N, Findlay, G, Smithies, M: Splenic rupture following cardiopulmonary resuscitation. Resuscitation 1997;35:171–173.Google Scholar
56.Zbar, RIS: Liver laceration after cardiopulmonary resuscitation: A case report. Heart Lung 1993;22:463.Google Scholar
57.Fosse, E, Lindberg, H. Left ventricular rupture following external chest compression. Acta Anesthesiol Scand 1996;40:502–504.Google Scholar
58.Gerry, JL, Bulkley, BH, Hutchins, GM: Rupture of the papillary muscle of the tricuspid valve: A complication of cardiopulmonary resuscitation and a rare cause of tricuspid insufficiency. Am J Cardiol 1977;40(5):825–828.CrossRefGoogle Scholar
59.Ma, MH, Huang, G, Wang, S, et al: Aortic valve disruption and regurgitation complicating CPR detected by transesophageal echocardiography. Am J Emerg Med 1994;12(5):601–602.Google Scholar
60.Baker, PB, Keyhani-Rofaghas, , Graham, RL: Dissecting hematoma (aneurysm)of coronary arteries. Am J Med 1986;80:317–319.Google Scholar
61.Dorsa, FB, Tuniek, PA, CuUiford, A, et al: Pseudoaneurysm of the thoracic aorta due to cardiopulmonary resuscitation: diagnosis by transesophageal echocardiography. Am Heart 1992;1398–1400.Google Scholar
62.Zuzarte, J, Chung-Park, M, Bahler, R, et al: Bilateral intrapulmonary hematomas. Am Rev Respir Dis 1990;142:1449–1552.Google Scholar
63.Degross, JM: Cardiopulmonary resuscitation: How much is it costing us? South Med J 1990;83(7):733–734.Google Scholar
64.Diem, SJ, Lantos, JD, Tulsky, JA: Cardiopulmonary resuscitation on television: miracles and misinformation. N Engl J Med 1996;334:1578–1582.Google Scholar
65.Becker, LB, Pepe, PE: Ensuring the effectiveness of community-wide emergency cardiac care. Ann Emerg Med 1993;22(2 Part 2):354–365.Google Scholar
66.Paraskos, JA: History of CPR and the role of the National Conference. Ann Emerg Med 1993;22(Part 2):275–280.Google Scholar
67.Montgomery, WH, Brown, DD, Hazinski, MF, et al: Citizen response to cardiopulmonary emergencies. Ann Emerg Med 1993;22(Part 2):428–434.CrossRefGoogle ScholarPubMed
68.Holmberg, M, Holmberg, S, Herlitz, J, et al: Survival after cardiac arrest outside hospital in Sweden. Resuscitation 1998:36:29–36.CrossRefGoogle ScholarPubMed
69.Stueven, H, Troiano, P, Thompson, B, et al: Bystander / first responder CPR: Ten years experience in a paramedic system. Ann Emerg Med 1986;15:707–710.CrossRefGoogle Scholar
70.Copley, DP, Mantle, JA, Rogers, WJ, et al: Improved outcome for prehospital cardiopulmonary collapse with resuscitation by bystanders. Circulation 1977;56(6):901–905.Google Scholar
71.Weil, MH, Tang, W, Amith, G, et al: Effectiveness of bystander CPR. JAMA 1996;275(15):1157–1158.CrossRefGoogle ScholarPubMed
72.Gallagher, EJ, Lombardi, G, Gennis, P: Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of- hospital cardiac arrest. JAMA 1995;274(24):1922–1925.Google Scholar
73.Guzy, PM, Pearce, ML, Greenfield, S: The survival benefit of bystander cardiopulmonary resuscitation in a paramedic served metropolitan area. Am J Public Health 1983;73:766–769.Google Scholar
74.Becker, L, Ostrander, MP, Barrett, J, et al: Outcome of CPR in a large metropolitan area — Where are the survivors? Ann Emerg Med 1991;20:355–361.CrossRefGoogle Scholar
75.Spaite, D, Hanlon, T, Criss, EA, et al: Prehospital cardiac arrest: The impact of witnessed collapse and bystander CPR in a metropolitan EMS system with short response times. Ann Emerg Med 1990;19:1264–1269.Google Scholar
76.Cummins, RO, Eisenberg, MS, Hallstom, AP, et al: Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. Am J Emerg Med 1985;3:114–118.CrossRefGoogle ScholarPubMed
77.Culley, LL, Clark, JJ, Eisenberg, MS, et al: Dispatcher-assisted telephone CPR: Common delays and time standards for delivery. Ann Emerg Med 1991;20:362–366.Google Scholar
78.Herlitz, J, Ekstrom, L, Wennerblom, B, et al: Effect of bystander initiated cardiopulmonary resuscitation on ventricular fibrillation and survival after witnessed cardiac arrest outside the hospital. Br Heart J 1994;72:408–412.Google Scholar
79.Kowalski, R, Thompson, BM, Horwitz, L, et al: Bystander CPR in prehospital coarse ventricular fibrillation. Ann Emerg Med 1984;13:1016–1020.Google Scholar
80.Eisenberg, MS, Horwood, BT, Cummins, RO, et al: Cardiac arrest and resuscitation: A tale of 29 cities. Ann Emerg Med 1990;19:179–186.Google Scholar
81.Callaham, M, Madsen, CD: Relation of timeliness of paramedic advanced life support intervention to outcome in out-of-hospital cardiac arrest treated by first responders with defibrillation. Ann Emerg Med 1996;27:638–648.Google Scholar
82.Sweeney, TA, Runge, JW, Gibbs, MA, et al: EMT defibrillation does not increase survival from sudden cardiac death in a two-tiered urban -suburban EMS system. Ann Emerg Med 1998;31(2):234–240.Google Scholar
83.Stratton, S, Nieman, JT: Effects of adding links to “The Chain of Survival”for prehospital cardiac arrest: A contrast in outcomes in 1975 and 1995 at a single institution. Ann Emerg Med 1998;31:471–476.CrossRefGoogle ScholarPubMed
84.Fischer, M, Fischer, NJ, Schutter, J: One-year survival after out-of- hospital cardiac arrest in Bonn city: Outcome report according to the “Utstein style”. Resuscitation 1997;33(3):233–243.Google Scholar
85.Weston, CF, Wilson, RJ, Jones, SD: Predicting survival from out-of-hospital cardiac arrest: A multivariate analysis. Resuscitation 1997;34(1):27–34.Google Scholar
86.Graves, JR, Herlitz, J, Bang, A, et al: Survivors of out-of-hospital arrest: Their prognosis, longevity, and functional status. Resuscitation 1997;35:117–121.Google Scholar
87.Beuret, P, Feihl, F, Vogt, P, et al: Cardiac arrest: Prognostic factors and outcome at one year. Resuscitation 1993;25:171–179.Google Scholar
88.Ochoa, FJ, Ramalle-Gomara, E, Visa, V, et al: The effect of rescuer fatigue on the quality of chest compressions. Resuscitation 1998;37(3):149–152.Google Scholar
89.Hoekstra, J: Bystander CPR: A review. Resuscitation 1990;20:97–113.Google Scholar
90.van Hoeyweghen, RJ, Bossaert, LL, Mullie, A, et al: Quality and efficiency of bystander CPR. Resuscitation 1993;26:47–52.Google Scholar
91.Swor, RA, Boji, Bernice, Cynar, M, et al: Bystander vs EMS first-respon-der CPR: Initial rhythm and outcome in witnessed non-monitored out-of-hospital cardiac arrest. Acad Emerg Med 1995;2:494–498.Google Scholar
92.Safar, P: Initiation of closed-chest cardiopulmonary resuscitation basic life support. A personal history. Resuscitation 1989;18:7–20.Google Scholar
93.Cobb, LA, Eliastram, M, Kerber, RE, et al: Report of the American Heart Association Task Force on the Future of Cardiopulmonary Resuscitation. Circulation 1992;85:2346–2355.Google Scholar
94.Pane, GA, Salness, KA: Targeted recruitment of senior citizens and cardiac patients to a mass CPR training course. Ann Emerg Med 1989;18:152–154.Google Scholar
95.Brennan, RT, Braslow, A: Are we training the right people yet? A survey of participants in public cardiopulmonary resuscitation classes. Resuscitation 1998;37(1):21–25.Google Scholar
96.Sigsbee, M, Geden, EA: Effects of anxiety on family members of patients with cardiac disease learning cardiopulmonary resuscitation. Heart Lung 1990;19:662–665.Google Scholar
97.Dracup, K, Guzy, PM, Taylor, SE, et al: Cardiopulmonary resuscitation (CPR)training: Consequences for family members of high-risk cardiac patients. Arch Intern Med 1986;146:1757–1761.Google Scholar
98.Murphy, RJ, Luepker, RV, Jacobs, DR, et al: Citizen cardiopulmonary resuscitation training and use in a metropolitan area: The Minnesota Heart Survey. Am J Public Health 1984;74:513–515.CrossRefGoogle Scholar
99.Brenner, BE, Kauffman, MD: Reluctance of internists and medical nurses to perform mouth-to-mouth resuscitation. Arch Intern Med 1993;153:1763–1769.Google Scholar
100.McCormack, AP, Damon, SK, Eisenberg, MS: Disagreeable physical characteristics affecting bystander CPR. Ann Emerg Med 1989;18:283–285.Google Scholar
101.Lightsey, DM, Priedman, KS, Forrester, JS, et al: A human immunodeficiency virus-resistant airway for cardiopulmonary resuscitation. Am J Emerg Med 1992:10:73–77.Google Scholar
102.Horowitz, BZ, Matheny, L. Health care professionals willingness to do mouth-to-mouth resuscitation. West J Med 1997;167(6):392–397.Google Scholar
103.Halperin, HR, Chandra, NC, Levin, HR, et al: Newer methods of improving blood flow during CPR. Ann Emerg Med 1996;27:553–562.Google Scholar
104.Safar, P: Resuscitation medicine research: Quo vadis. Ann Emerg Med 1996;27:542–552.Google Scholar
105.Eisenberg, MS, Pantridge, F, Cobb, L, et al: The revolution and evolution of prehospital cardiac care. Arch Intern Med 1996;156:1611–1619.Google Scholar
106.Bilger, MC, Giesen, BC, Wollan, PC, et al: Improved retention of the EMS activation component (EMSAC)in adult CPR education. Resuscitation 1997;35:219–224.Google Scholar
107.Eisenberg, MS, Hallstrom, AP, Carter, WB, Cummins, RO, et al: Emergency CPR instruction via telephone. Am J Public Health 1985;75:47–50.CrossRefGoogle ScholarPubMed
108.Silvast, T, Ekstrand, A: The effect of experience of on-site physicians on survival from prehospital cardiac arrest. Resuscitation 1996;31:101–105.Google Scholar
109.Sanders, AB, Berg, RA, Burress, M, et al: The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community. Ann Emerg Med 1994;23(1):56–59.Google Scholar
110.Ramirez, AG, Weaver, FJ, Raizner, AE, et al: The efficacy of lay CPR instruction: An evaluation. Am J Pub Health 1977;67(11):1093–1095.Google Scholar
111.Tweed, WA, Wilson, E, Isfeld, B: Retention of cardiopulmonary resuscitation skills after initial over-training. Crit Care Med 1980;8(11):651–653.Google Scholar
112.Mancini, M, Kaye, W: The effect of time since training on house officer's retention of cardiopulmonary resuscitation skills. Am J Emerg Med 1985;3:31–32.Google Scholar
113.Kaye, W, Mancini, M: Retention of cardiopulmonary resuscitation skills by physicians, registered nurses, and the general public. Crit Care Med 1986;14(7):620–622.Google Scholar
114.Kiskaddon, RT, Sternbach, GL: Retention of CPR skills. Am J Emerg Med 1985;3:479.Google Scholar
115.Morgan, CL, Donnelly, PD, Lester, CA, et al: Effectiveness of the BBC's 999 training roadshows on cardiopulmonary resuscitation: Video performance of cohort of unforewarned participants at home six months afterwards. BMJ 1996;313(7062):912–916.Google Scholar
116.Sternbach, GL, Kiskaddon, RT, Fossel, M, et al: The retention of cardiopulmonary resuscitation skills. J Emerg Med 1984;2:33–36.Google Scholar
117.Yakel, ME: Retention of cardiopulmonary resuscitation skills among nursing personnel: What makes the difference? Heart Lung 1989;18(5):520–525.Google Scholar
118.Berden, HJJM, Willems, FF, Hendrick, JMA, et al: How frequently should basic cardiopulmonary resuscitation training be repeated to maintain adequate skills? BMJ 1993;306:1576.Google Scholar
119.Atkins, JM.Education and evaluation in emergency cardiac care programs (CPR and advanced cardiac life support): State of the art. Circulation 1986;74(Suppl IV):IV–18.Google Scholar
120.Eisenberg, M, Damon, S, Mandel, L, et al: CPR instruction by videotape: Results of a community project. Ann Emerg Med 1985;25(2):198–202.Google Scholar
121.Todd, KH, Braslow, RT, Brennan, RT, et al: Randomized, controlled trial of video self-instruction versus traditional CPR training. Ann Emerg Med 1998;31:364–369.Google Scholar
122.Braslow, A, Brennan, RT, Newman, MM, et al: CPR training without an instruction: Development and evaluation of a video self-instructional system for effective performance of cardiopulmonary resuscitation. Resuscitation 1997;34:207–220.Google Scholar
123.Eberle, B, Dick, WF, Schneider, T, et al: Checking the carotid pulse check: Diagnostic accuracy of first responders in patients with and without a pulse. Resuscitation 1996;33(2):107–116.Google Scholar
124.Brennan, RT, Braslow, A, Batcheller, AM, et al: A reliable and valid method for evaluating cardiopulmonary resuscitation training outcomes. Resuscitation 1996;32(2):85–93.Google Scholar
125.Handley, JA, Handley, AJ: Four-step CPR — Improving skill retention. Resuscitation 1998;36:3–8.Google Scholar
126.Nolan, J, Gwinnutt, C: 1998 European guidelines on resuscitation: Simplifications should make them easier to teach and implement. BMJ 1998;316(7148):1844–1845. Editorial.Google Scholar
127.Knox, HT, Braslow, A, Brennan, RT, Lowery, DW, et al: Randomized controlled trial of video self-instruction versus traditional CPR training. Ann Emerg Med 1998;31(3):364–369.Google Scholar
128.Elding, C, Baskett, P, Hughes, A: The study of the effectiveness of chest compressions using the CPR-plus. Resuscitation 1998;36:169–173.Google Scholar
129.Berg, RA, Kern, KB, Sanders, AB, et al: Bystander cardiopulmonary resuscitation: Is ventilation necessary? Circulation 1993;88(Part 1):1907–1915.Google Scholar
130.Idris, AH: Reassessing the need for ventilation during CPR. Ann Emerg Med 1996;27:569–575.Google Scholar
131.Ornato, JP: Should bystanders perform mouth-to-mouth ventilation during resuscitation? Chest 1994;106(6):1641–1642. Editorial.Google Scholar
132.Wenzel, V, Idris, AH, Banner, MJ, et al: The composition of gas given by mouth-to-mouth ventilation during CPR. Chest 1994;106:1806–1810.Google Scholar
133.Becker, LB, Beg, RA, Pepe, PE, et al: A reappraisal of mouth-to-mouth ventilation during bystander-initiated cardiopulmonary resuscitation. Resuscitation 1997;35:189–201.Google Scholar
134.Shapiro, B: Should the ABCs of basic CPR become the CABs? Crit Care Med 1998;26:364–368.Google Scholar
135.Safar, P, Bircher, N, Pretto, E, et al: Reappraisal of mouth-to-mouth ventilation during bystander initiated CPR. Circulation 1998;98(6):608–610.Google Scholar
136.Cohen, TJ, Goldner, BG, Maccaro, PC, et al: A comparison of active compression-decompression cardiopulmonary resuscitation with standard cardiopulmonary resuscitation for cardiac arrests occurring in the hospital. N Engl J Med 1993;329:1918–1921.Google Scholar
137.Lurie, KG, Shultz, JJ, Callaham, ML, et al: Evaluation of active compression-decompression CPR in victims of out-of-hospital cardiac arrest. JAMA 1994;271(18):1405–1411.Google Scholar
138. Editor: Active compression-decompression CPR for cardiac arrest did not improve survival or neurologic outcomes. ACP Journal Club 1992;125:39.Google Scholar
139.Panzer, W, Bretthauer, M, Klingler, H, et al: ACD versus standard CPR in a prehospital setting. Resuscitation 1996;33(2):117–124.Google Scholar
140.Mauer, D, Schneider, T, Dick, W, et al: Active compression-decompression resuscitation: A prospective, randomized study in a two-tiered EMS system with physicians in the field. Resuscitation 1996;33(2):125–134.Google Scholar
141.Plaisance, P, Adnet, F, Vicaut, E, et al: Benefit of active compression-decompression cardiopulmonary resuscitation as a prehospital advanced life support: A randomized multicenter study. Circulation 1997;95(4):955–961.Google Scholar
142.Rabi, W, Baubin, M, Haid, C, et al: Review of active compression-decompression cardiopulmonary resuscitation (ACD-CPR): Analysis of iatrogenic complications and their biomechanical explanation. Forensic Science International: 1997;89(3):175–183.Google Scholar
143.Sack, JB, Kesselbrenner, MB, et al: Hemodynamics, survival benefits, and complications of interposed abdominal compression during cardiopulmonary resuscitation. Acad Emerg Med 1994;1(5):490–497.Google Scholar
144. Editor: Interposed abdominal counter-pulsation during cardiopulmonary resuscitation improved outcomes after in-hospital cardiac arrest. ACP Journal Club 1992;116:64.Google Scholar
145.Luce, JM, Weil, MH, Tung, W, et al: Wolf Creek IV Conference on cardiopulmonary resuscitation. New Horizons 1997;5(2):95–172.Google Scholar
146.Emergency Cardiac Care Committee and Subcommittee, American Heart Association: Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA 1992;268(16):2171–2302.Google Scholar
147.Dickinson, ET, Verdile, VP, Schneider, RM, et al: Effectiveness of mechanical versus manual chest compressions in out-of-hospital cardiac arrest resuscitation: A pilot study. Am J Emerg Med 1998;16(3):289–293.Google Scholar
148.Ebell, MH, Kruse, JA: A proposed model for the cost of cardiopulmonary resuscitation. Medical Care 1994;32(6):640–649.Google Scholar
149.Lee, KH, Angus, DC, Abramson, NS: Cardiopulmonary resuscitation: What cost to cheat death? Crit Care Med 1996;24(12):2046–2052.CrossRefGoogle ScholarPubMed
150.Vrtis, MC: Cost/benefit analysis of cardiopulmonary resuscitation: A history of CPR - Part I. Nursing Management 1992 23(4):50–54.Google Scholar
151.Vrtis, MC: Cost/benefit analysis of cardiopulmonary resuscitation: A comprehensive study - Part II. Nursing Management 1992;23(5):44–51.Google Scholar
152.Ginsburg, W: Prepare to be shocked: the evolving standard of care in treating sudden cardiac arrest. Am J Emerg Med 1998;16(3):315–319.Google Scholar
153.Cummins, RO, Eisenberg, MS, Moore, JE, et al: Automatic external defibrillators: Clinical, training, psychological, and public health issues. Ann Emerg Med 1985;14:755–760.Google Scholar
154.Berg, RA, Sanders, AB, Milander, M, et al: Efficacy of audio-prompted rate guidance in improving resuscitator performance of cardiopulmonary resuscitation on children. Acad Emerg Med 1994;1(1):35–40.Google Scholar
155.Simmons, M, Deao, D, Moon, L, et al: Bench evaluation: Three face-shield CPR barrier devices. Resp Care 1995;40(6):618–623.Google Scholar
156.Martens, P, Calle, P, Vanhaute, O, et al: Theoretical calculation of maximum attainable benefit of public access defibrillation in Belgium. Resuscitation 1998;36:161–163.Google Scholar
157.Olson, CM: The issue of CPR. JAMA 1992;268(16):2297–2298. Editorial.Google Scholar
158.Paraskos, JA: Emergency cardiac care: The science behind the art. JAMA 1992;268(16):2296–2297. Editorial.Google Scholar
159.Kellerman, AL, Hackman, BB, Somes, G: Predicting the outcome of unsuccessful advanced cardiac life support. JAMA 1993;270:1433–1436.Google Scholar
160.Bonnin, MJ, Pepe, PE, Kimball, KT: Distinct criteria for termination of resuscitation in the out-of-hospital setting. JAMA 1993;270:1457–1462.Google Scholar
161.Bains, J: From reviving the living to raising the dead: The making of cardiac resuscitation. Social Science and Medicine 1998;47(90):1341–1349.Google Scholar
162.Ebell, MH, Kruse, JA, Smith, M, et al: Failure of three decision rules to predict the outcome of in-hospital cardiopulmonary resuscitation. Medical Decision Making 1997;17(2):171–177.Google Scholar
163.Hilberman, M, Kutner, J, Parsons, D, et al: Marginally effective medical care: Ethical analysis of issues in cardiopulmonary resuscitation. J Med Ethics 1997;23(6):361–367.Google Scholar
164.Marik, PE, Craft, M: An outcomes analysis of in-hospital cardiopulmonary resuscitation: The futility rationale for do not resuscitate orders. J Crit Care 1997;21(3):142–146.Google Scholar
165.Borzotta, A, Lipman, G, Dunn, PM. Survival rates and cardiopulmonary resuscitation. Crit Care Med 1998;26(70):1293–1294.Google Scholar
166.Ebell, MH, Becker, LA, Barry, HC, et al: Survival after in-hospital cardiopulmonary resuscitation: A meta-analysis, J Gen Intern Med 1998;13:805–816.Google Scholar
167.DeBehnke, DJ, Swart, GL: Cardiac arrest. Emerg Med Clin N Amer 1996;14(1):57–81.Google Scholar
168.Kay, CF: Cardiopulmonary resuscitation: A chain of many links. Ann Intern Med 1974;80(3):411–413.Google Scholar
169.Shohet, SB, Sweet, RH: The combined use of external cardiac massage, external cardiac defibrillation, and external cardiac stimulation. N Engl J Med 1962;267:976–977.Google Scholar
170.Kouwnhoven, WB, Jude, JR, Knickerbocker, GG: Closed-chest cardiac massage. JAMA 1960;173:1064–1067.Google Scholar