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An Evolution, Not a Revolution

Mary Ann Peberdy, MD; Joseph P. Ornato, MD

JAMA. 2008;299(10):1188-1190.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

There was a time not long ago when the quality and quantity of chest compressions did not seem that important during resuscitation—at least not in comparison with early defibrillation. A ventricular tachyarrhythmia is the initiating event in more than 80% of patients who develop out-of-hospital, primary cardiac arrest during ambulatory electrocardiographic monitoring.¹ Survival declines rapidly if defibrillation is not performed in the first few minutes (defibrillation phase) because myocardial adenosine triphosphate (ATP) levels begin to decrease as fibrillating myocardial cells continue to consume ATP at a nearly normal rate.^2-3

As a result, ventricular fibrillation (VF) is the presenting rhythm in only 22% to 35% of out-of-hospital cardiac arrest cases when emergency medical services (EMS) personnel arrive on scene.^4-5 By this time, myocardial ATP stores have often declined to critical levels and a defibrillation shock will usually terminate VF but frequently results in . . . [Full Text of this Article]

Author Affiliations: Departments of Internal Medicine (Cardiology) (Dr Peberdy) and Emergency Medicine (Dr Ornato), Virginia Commonwealth University, Richmond.

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