Editorial| Volume 169, P154-155, December 2021

Is the writing on the skull?

  • Cornelia Genbrugge
    Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium
    Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC) Université Catholique de Louvain, Belgium
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  • David D Salcido
    Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
    School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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      Peter Safar, together with others, established the basic treatment of cardiac arrest in the 1950s and 1960s by introducing the Airway, Breathing and Circulation sequence, which became the Basic Life Support algorithm.
      • Safar P.
      Initiation of closed-chest cardiopulmonary resuscitation basic life support. A personal history.
      • Safar P.
      Ventilation and Circulation with Closed-Chest Cardiac Massage in Man.
      This was later transformed into Advanced Life Support by adding drugs and early defibrillation during cardiopulmonary resuscitation (CPR). Looking back on the fundamental studies leading to these developments, they were performed in laboratory or operating room settings with invasive blood pressure monitoring.
      • Safar P.
      Ventilation and Circulation with Closed-Chest Cardiac Massage in Man.
      If those measurements were not available, a femoral or carotid pulse was used to measure the effect of the treatment. A pulse was made palpable or improved by either moving the patient to a harder surface or by using more body weight for compressions.
      • Kouwenhoven W.B.
      • Jude J.R.
      • Knickerbocker G.G.
      Closed-chest cardiac massage.
      These adaptations in chest compression delivery were the first steps to a patient-tailored cardiac arrest treatment. It is interesting to see that after all these years, we still cannot say that we have the next logical evolution of resuscitation, Adaptive Life Support. In such an approach, real-time analysis of the patient would actively gauge the physiologic effects of CPR in progress and give every cardiac arrest patient, regardless of their age and body constitution, the optimal treatment. Should a female, 36 year-old cardiac arrest patient receive the same treatment as a 66 year-old men with obesity? We need not reach beyond clinical intuition for the answer.
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