Skip to main content
SpringerLink
Log in

Cardiopulmonary Resuscitation

  • Chapter
Surgical Intensive Care Medicine

  • 3147 Accesses

Abstract

Cardiopulmonary resuscitation (CPR) should be a basic skill for every intensive care physician. An estimated 200,000 individuals suffer from in-hospital cardiac arrest in the United States each year.1,2 Half of these incidents occur in intensive care units (ICUs).3 Restoration of spontaneous circulation (ROSC) can be achieved in 40–50% of patients resuscitated in-hospital, yet only 15–20% survive to be discharged.3,4

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. National Center for Health Statistics. Health, United States, 2006. With chartbook on trends in the health of Americans. Hyattsville, MD; 2006.

    Google Scholar 

  2. Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14 720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003;58:297–308.

    PubMed  Google Scholar 

  3. Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006;295:50–57.

    PubMed  CAS  Google Scholar 

  4. Gwinnutt CL, Columb M, Harris R. Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines. Resuscitation. 2000;47:125–135.

    PubMed  CAS  Google Scholar 

  5. International Liaison Committee on Resuscitation. International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation. 2005;67:181–341.

    Google Scholar 

  6. American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005;112:IV1–IV211.

    Google Scholar 

  7. European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2005. Resuscitation. 2005;67:S1–S189.

    Google Scholar 

  8. Müllner M, Hirschl MM, Herkner H, et al. Creatine kinase-MB fraction and cardiac troponin T to diagnose acute myocardial infarction after cardiopulmonary resuscitation. J Am Coll Cardiol. 1996;28:1220–1225.

    PubMed  Google Scholar 

  9. Spaulding CM, Joly LM, Rosenberg A, et al. Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med. 1997;336:1629–1633.

    PubMed  CAS  Google Scholar 

  10. Vanbrabant P, Dhondt E, Billen P, Sabbe M. Aetiology of unsuccessful prehospital witnessed cardiac arrest of unclear origin. Eur J Emerg Med. 2006;13:144–147.

    PubMed  Google Scholar 

  11. Kause J, Smith G, Prytherch D, et al. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom – the ACADEMIA study. Resuscitation. 2004;62:275–282.

    PubMed  Google Scholar 

  12. Berg RA, Sorrell VL, Kern KB, et al. Magnetic resonance imaging during untreated ventricular fibrillation reveals prompt right ventricular overdistention without left ventricular volume loss. Circulation. 2005;111:1136–1140.

    PubMed  Google Scholar 

  13. Schipke JD, Heusch G, Sanii AP, et al. Static filling pressure in patients during induced ventricular fibrillation. Am J Physiol Heart Circ Physiol. 2003;285:H2510–H2515.

    PubMed  CAS  Google Scholar 

  14. Steen S, Liao Q, Pierre L, et al. The critical importance of minimal delay between chest compressions and subsequent defibrillation: a haemodynamic explanation. Resuscitation. 2003;58:249–258.

    PubMed  Google Scholar 

  15. Miyamoto O, Auer RN. Hypoxia, hyperoxia, ischemia, and brain necrosis. Neurology. 2000;54:362–371.

    PubMed  CAS  Google Scholar 

  16. Simon RP. Hypoxia versus ischemia. Neurology. 1999;52:7–8.

    PubMed  CAS  Google Scholar 

  17. Rossen R, Kabat H, Anderson JP. Acute arrest of cerebral circulation in man. Arch Neurol Psychiatry. 1943;50:510–528.

    Google Scholar 

  18. Cavus E, Bein B, Dörges V, et al. Brain tissue oxygen pressure and cerebral metabolism in an animal model of cardiac arrest and cardiopulmonary resuscitation. Resuscitation. 2006;71:97–106.

    PubMed  CAS  Google Scholar 

  19. Imberti R, Bellinzona G, Riccardi F, et al. Cerebral perfusion pressure and cerebral tissue oxygen tension in a patient during cardiopulmonary resuscitation. Intensive Care Med. 2003;29:1016–1019.

    PubMed  Google Scholar 

  20. Corbett RJT, Laptook AR. 31P NMR relaxation does not affect the quantitation of changes in phosphocreatine, inorganic phosphate, and ATP measured in vivo during complete ischemia in swine brain. J Neurochem. 1993;61:144–149.

    PubMed  CAS  Google Scholar 

  21. LaManna JC, Griffith JK, Cordisco BR, et al. Rapid recovery of rat brain intracellular pH after cardiac arrest and resuscitation. Brain Res. 1995;687:175–181.

    PubMed  CAS  Google Scholar 

  22. Winn HR, Rubio R, Berne RM. Brain adenosine production in the rat during 60 seconds of ischemia. Circ Res. 1979;45:486–492.

    PubMed  CAS  Google Scholar 

  23. Hossmann KA, Sakaki S, Zimmerman V. Cation activities in reversible ischemia of the cat brain. Stroke. 1977;8:77–81.

    PubMed  CAS  Google Scholar 

  24. Tanaka E, Yamamoto S, Kudo Y, et al. Mechanisms underlying the rapid depolarization produced by deprivation of oxygen and glucose in rat hippocampal CA1 neurons in vitro. J Neurophysiol. 1997;78:891–902.

    PubMed  CAS  Google Scholar 

  25. Benveniste H, Drejer J, Schousboe A, Diemer NH. Elevation of the extracellular concentrations of glutamate and aspartate in rat hippocampus during transient cerebral ischemia monitored by intracerebral microdialysis. J Neurochem. 1984;43:1369–1374.

    PubMed  CAS  Google Scholar 

  26. Bickler PE, Hansen BM. Causes of calcium accumulation in rat cortical brain slices during hypoxia and ischemia: role of ion channels and membrane damage. Brain Res. 1994;665:269–276.

    PubMed  CAS  Google Scholar 

  27. Silver IA, Erecińska M. Intracellular and extracellular changes of [Ca2+] in hypoxia and ischemia in rat brain in vivo. J Gen Physiol. 1990;95:837–866.

    PubMed  CAS  Google Scholar 

  28. Kristián T, Siesjö BK. Calcium in ischemic cell death. Stroke. 1998;29:705–718.

    PubMed  Google Scholar 

  29. White BC, Sullivan JM, DeGracia DJ, et al. Brain ischemia and reperfusion: molecular mechanisms of neuronal injury. J Neurol Sci. 2000;179:1–33.

    PubMed  CAS  Google Scholar 

  30. Kalimo H, Garcia JH, Kamijyo Y, et al. The ultrastructure of “brain death”. II. Electron microscopy of feline cortex after complete ischemia. Virchows Arch B Cell Pathol. 1977;25:207–220.

    PubMed  CAS  Google Scholar 

  31. Sakamoto A, Ohnishi ST, Ohnishi T, Ogawa R. Relationship between free radical production and lipid peroxidation during ischemia-reperfusion injury in the rat brain. Brain Res. 1991;554:186–192.

    PubMed  CAS  Google Scholar 

  32. Tanaka K, Shirai T, Nagata E, et al. Immunohistochemical detection of nitrotyrosine in postischemic cerebral cortex in gerbil. Neurosci Lett. 1997;235:85–88.

    PubMed  CAS  Google Scholar 

  33. Watson BD, Busto R, Goldberg WJ, et al. Lipid peroxidation in vivo induced by reversible global ischemia in rat brain. J Neurochem. 1984;42:268–274.

    PubMed  CAS  Google Scholar 

  34. Böttiger BW, Schmitz B, Wiessner C, et al. Neuronal stress response and neuronal cell damage after cardiocirculatory arrest in rats. J Cereb Blood Flow Metab. 1998;18:1077–1087.

    PubMed  Google Scholar 

  35. Chen J, Nagayama T, Jin K, et al. Induction of caspase-3-like protease may mediate delayed neuronal death in the hippo­campus after transient cerebral ischemia. J Neurosci. 1998;18:4914–4928.

    PubMed  CAS  Google Scholar 

  36. Lindvall O, Ernfors P, Bengzon J, et al. Differential regulation of mRNAs for nerve growth factor, brain-derived neurotrophic factor, and neurotrophin 3 in the adult rat brain following cerebral ischemia and hypoglycemic coma. Proc Natl Acad Sci USA. 1992;89:648–652.

    PubMed  CAS  Google Scholar 

  37. McGahan L, Hakim AM, Robertson GS. Hippocampal Myc and p53 expression following transient global ischemia. Brain Res Mol Brain Res. 1998;56:133–145.

    PubMed  CAS  Google Scholar 

  38. Padosch SA, Popp E, Vogel P, Böttiger BW. Altered protein expression levels of Fas/CD95 and Fas ligand in differentially vulnerable brain areas in rats after global cerebral ischemia. Neurosci Lett. 2003;338:247–251.

    PubMed  CAS  Google Scholar 

  39. Lim C, Alexander MP, LaFleche G, et al. The neurological and cognitive sequelae of cardiac arrest. Neurology. 2004;63:1774–1778.

    PubMed  CAS  Google Scholar 

  40. Roine RO, Kajaste S, Kaste M. Neuropsychological sequelae of cardiac arrest. JAMA. 1993;269:237–242.

    PubMed  CAS  Google Scholar 

  41. Van Alem AP, de Vos R, Schmand B, Koster RW. Cognitive impairment in survivors of out-of-hospital cardiac arrest. Am Heart J. 2004;148:416–421.

    PubMed  Google Scholar 

  42. Chang WT, Ma MHM, Chien KL, et al. Postresuscitation myocardial dysfunction: correlated factors and prognostic implications. Intensive Care Med. 2007;33:88–95.

    PubMed  Google Scholar 

  43. Kern KB, Hilwig RW, Rhee KH, Berg RA. Myocardial dysfunction after resuscitation from cardiac arrest: an example of global myocardial stunning. J Am Coll Cardiol. 1996;28:232–240.

    PubMed  CAS  Google Scholar 

  44. Laurent I, Monchi M, Chiche JD, et al. Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol. 2002;40:2110–2116.

    PubMed  Google Scholar 

  45. Müllner M, Domanovits H, Sterz F, et al. Measurement of myocardial contractility following successful resuscitation: quantitated left ventricular systolic function utilising non-invasive wall stress analysis. Resuscitation. 1998;39:51–59.

    PubMed  Google Scholar 

  46. Palmer BS, Hadziahmetovic M, Veci T, Angelos MG. Global ischemic duration and reperfusion function in the isolated perfused rat heart. Resuscitation. 2004;62:97–106.

    PubMed  Google Scholar 

  47. Gazmuri RJ, Deshmukh S, Shah PR. Myocardial effects of repeated electrical defibrillations in the isolated fibrillating rat heart. Crit Care Med. 2000;28:2690–2696.

    PubMed  CAS  Google Scholar 

  48. Wilson CM, Allen JD, Bridges JB, Adgey AAJ. Death and damage caused by multiple direct current shocks: studies in an animal model. Eur Heart J. 1988;9(11):1257–1265.

    PubMed  CAS  Google Scholar 

  49. Yamaguchi H, Weil MH, Tang W, et al. Myocardial dysfunction after electrical defibrillation. Resuscitation. 2002;54:289–296.

    PubMed  Google Scholar 

  50. Tang W, Weil MH, Sun S, et al. Epinephrine increases the severity of postresuscitation myocardial dysfunction. Circulation. 1995;92(10):3089–3093.

    PubMed  CAS  Google Scholar 

  51. Adrie C, Adib-Conquy M, Laurent I, et al. Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis-like” syndrome. Circulation. 2002;106:562–568.

    PubMed  Google Scholar 

  52. Böttiger BW, Motsch J, Braun V, et al. Marked activation of complement and leukocytes and an increase in the concentrations of soluble endothelial adhesion molecules during cardiopulmonary resuscitation and early reperfusion after cardiac arrest in humans. Crit Care Med. 2002;30:2473–2480.

    PubMed  Google Scholar 

  53. Mussack T, Biberthaler P, Gippner-Steppert C, et al. Early cellular brain damage and systemic inflammatory response after cardiopulmonary resuscitation or isolated severe head trauma: a comparative pilot study on common pathomechanisms. Resuscitation. 2001;49:193–199.

    PubMed  CAS  Google Scholar 

  54. Adrie C, Monchi M, Laurent I, et al. Coagulopathy after successful cardiopulmonary resuscitation following cardiac arrest: implication of the protein C anticoagulant pathway. J Am Coll Cardiol. 2005;46:21–28.

    PubMed  Google Scholar 

  55. Böttiger BW, Motsch J, Böhrer H, et al. Activation of blood coagulation after cardiac arrest is not balanced adequately by activation of endogenous fibrinolysis. Circulation. 1995;92:2572–2578.

    PubMed  Google Scholar 

  56. Boidin MP. Airway patency in the unconscious patient. Br J Anaesth. 1985;57:306–310.

    PubMed  CAS  Google Scholar 

  57. Nandi PR, Charlesworth CH, Taylor SJ, et al. Effect of general anaesthesia on the pharynx. Br J Anaesth. 1991;66:157–162.

    PubMed  CAS  Google Scholar 

  58. Ruben HM, Elam JO, Ruben AM, Greene DG. Investigation of upper airway problems in resuscitation. 1. Studies of pharyngeal x-rays and performance by laymen. Anesthesiology. 1961;22:271–279.

    PubMed  CAS  Google Scholar 

  59. Safar P, Escarraga LA, Chang F. Upper airway obstruction in the unconscious patient. J Appl Physiol. 1959;14:760–764.

    PubMed  CAS  Google Scholar 

  60. Guildner CW. Resuscitation – opening the airway. A comparative study of techniques for opening an airway obstructed by the tongue. JACEP. 1976;5:588–590.

    PubMed  CAS  Google Scholar 

  61. Clark JJ, Larsen MP, Culley LL, et al. Incidence of agonal respirations in sudden cardiac arrest. Ann Emerg Med. 1992;21:1464–1467.

    PubMed  CAS  Google Scholar 

  62. Ochoa FJ, Ramalle-Gómara E, Carpintero JM, et al. Competence of health professionals to check the carotid pulse. Resuscitation. 1998;37:173–175.

    PubMed  CAS  Google Scholar 

  63. Ruppert M, Reith MW, Widmann JH, et al. Checking for breathing: evaluation of the diagnostic capability of emergency medical services personnel, physicians, medical students, and medical laypersons. Ann Emerg Med. 1999;34:720–729.

    PubMed  CAS  Google Scholar 

  64. Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed-chest cardiac massage. JAMA. 1960;173:1064–1067.

    PubMed  CAS  Google Scholar 

  65. Paradis NA, Martin GB, Goetting MG, et al. Simultaneous aortic, jugular bulb, and right atrial pressures during cardiopulmonary resuscitation in humans. Insights into mechanisms. Circulation. 1989;80:361–368.

    PubMed  CAS  Google Scholar 

  66. Redberg RF, Tucker KJ, Cohen TJ, et al. Physiology of blood flow during cardiopulmonary resuscitation. A transesophageal echocardiographic study. Circulation. 1993;88:534–542.

    PubMed  CAS  Google Scholar 

  67. Werner JA, Greene HL, Janko CL, Cobb LA. Visualization of cardiac valve motion in man during external chest compression using two-dimensional echocardiography. Implications regarding the mechanism of blood flow. Circulation. 1981;63:1417–1421.

    PubMed  CAS  Google Scholar 

  68. Rivers EP, Lozon J, Enriquez E, et al. Simultaneous radial, femoral, and aortic arterial pressures during human cardiopulmonary resuscitation. Crit Care Med. 1993;21:878–883.

    PubMed  CAS  Google Scholar 

  69. Swenson RD, Weaver WD, Niskanen RA, et al. Hemodynamics in humans during conventional and experimental methods of cardiopulmonary resuscitation. Circulation. 1988;78:630–639.

    PubMed  CAS  Google Scholar 

  70. Ornato JP, Gonzalez ER, Garnett AR, et al. Effect of cardiopulmonary resuscitation compression rate on end-tidal carbon dioxide concentration and arterial pressure in man. Crit Care Med. 1988;16:241–245.

    PubMed  CAS  Google Scholar 

  71. Eftestøl T, Sunde K, Steen PA. Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. Circulation. 2002;105:2270–2273.

    PubMed  Google Scholar 

  72. Kern KB, Hilwig RW, Berg RA, et al. Importance of continuous chest compressions during cardiopulmonary resuscitation: improved outcome during a simulated single lay-rescuer scenario. Circulation. 2002;105:645–649.

    PubMed  Google Scholar 

  73. Safar P, Escarraga LA, Elam JO. A comparison of the mouth-to-mouth and mouth-to-airway methods of artificial respiration with the chest-pressure arm-lift methods. N Engl J Med. 1958;258:671–677.

    PubMed  CAS  Google Scholar 

  74. Brenner BE, Van DC, Cheng D, Lazar EJ. Determinants of reluctance to perform CPR among residents and applicants: the impact of experience on helping behavior. Resuscitation. 1997;35:203–211.

    PubMed  CAS  Google Scholar 

  75. Ornato JP, Hallagan LF, McMahan SB, et al. Attitudes of BCLS instructors about mouth-to-mouth resuscitation during the AIDS epidemic. Ann Emerg Med. 1990;19:151–156.

    PubMed  CAS  Google Scholar 

  76. Campbell TP, Stewart RD, Kaplan RM, et al. Oxygen enrichment of bag-valve-mask units during positive-pressure ventilation: a comparison of various techniques. Ann Emerg Med. 1988;17:232–235.

    PubMed  CAS  Google Scholar 

  77. Quintana S, Martínez Pérez J, Alvarez M, et al. Maximum FiO2 in minimum time depending on the kind of resuscitation bag and oxygen flow. Intensive Care Med. 2004;30:155–158.

    PubMed  Google Scholar 

  78. Alexander R, Hodgson P, Lomax D, Bullen C. A comparison of the laryngeal mask airway and Guedel airway, bag and facemask for manual ventilation following formal training. Anaesthesia. 1993;48:231–234.

    PubMed  CAS  Google Scholar 

  79. Dörges V, Sauer C, Ocker H, et al. Airway management during cardiopulmonary resuscitation – a comparative study of bag-valve-mask, laryngeal mask airway and combitube in a bench model. Resuscitation. 1999;41:63–69.

    Google Scholar 

  80. Redfern D, Rassam S, Stacey MR, Mecklenburgh JS. Comparison of face masks in the bag-mask ventilation of a manikin. Eur J Anaesthesiol. 2006;23:169–172.

    PubMed  CAS  Google Scholar 

  81. Stone BJ, Chantler PJ, Baskett PJF. The incidence of regurgitation during cardiopulmonary resuscitation: a comparison between the bag valve mask and laryngeal mask airway. Resuscitation. 1998;38:3–6.

    PubMed  CAS  Google Scholar 

  82. Katz SH, Falk JL. Misplaced endotracheal tubes by paramedics in an urban emergency medical services system. Ann Emerg Med. 2001;37:32–37.

    PubMed  CAS  Google Scholar 

  83. Timmermann A, Eich C, Russo SG, et al. Prehospital airway management: a prospective evaluation of anaesthesia trained emergency physicians. Resuscitation. 2006;70:179–185.

    PubMed  Google Scholar 

  84. Aufderheide TP, Lurie KG. Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med. 2004;32:S345–S351.

    PubMed  Google Scholar 

  85. Langhelle A, Sunde K, Wik L, Steen PA. Arterial blood-gases with 500- versus 1000-ml tidal volumes during out-of-hospital CPR. Resuscitation. 2000;45:27–33.

    PubMed  CAS  Google Scholar 

  86. Wenzel V, Keller C, Idris AH, et al. Effects of smaller tidal volumes during basic life support ventilation in patients with respiratory arrest: good ventilation, less risk? Resuscitation. 1999;43:25–29.

    PubMed  CAS  Google Scholar 

  87. Dorph E, Wik L, Strømme TA, et al. Quality of CPR with three different ventilation:compression ratios. Resuscitation. 2003;58:193–201.

    PubMed  CAS  Google Scholar 

  88. Sanders AB, Kern KB, Berg RA, et al. Survival and neurologic outcome after cardiopulmonary resuscitation with four different chest compression-ventilation ratios. Ann Emerg Med. 2002;40:553–562.

    PubMed  Google Scholar 

  89. Babbs CF, Kern KB. Optimum compression to ventilation ratios in CPR under realistic, practical conditions: a physiological and mathematical analysis. Resuscitation. 2002;54:147–157.

    PubMed  Google Scholar 

  90. Yannopoulos D, Aufderheide TP, Gabrielli A, et al. Clinical and hemodynamic comparison of 15:2 and 30:2 compression-to-ventilation ratios for cardiopulmonary resuscitation. Crit Care Med. 2006;34:1444–1449.

    PubMed  Google Scholar 

  91. Odegaard S, Saether E, Steen PA, Wik L. Quality of lay person CPR performance with compression: ventilation ratios 15:2, 30:2 or continuous chest compressions without ventilations on manikins. Resuscitation. 2006;71:335–340.

    PubMed  Google Scholar 

  92. Deschilder K, De Vos R, Stockman W. The effect on quality of chest compressions and exhaustion of a compression-ventilation ratio of 30:2 versus 15:2 during cardiopulmonary resuscitation – a randomised trial. Resuscitation. 2007;74(1):113–118.

    PubMed  Google Scholar 

  93. Hostler D, Rittenberger JC, Roth R, Callaway CW. Increased chest compression to ventilation ratio improves delivery of CPR. Resuscitation. 2007;74(3):446–452.

    PubMed  Google Scholar 

  94. Abildgaard PC. Tentamina electrica in animalibus instituta. Societatis Medicae Havniensis Collectanea. 1775;2:157–161. As cited in: Driscol TE, Ratnoff OD, Nygaard OF. The remarkable Dr. Abildgaard and countershock. The bicentennial of his electrical experiments on animals. Ann Intern Med. 1975; 83: 878–882.

    Google Scholar 

  95. Lown B, Amarasingham R, Neuman J. New method for terminating cardiac arrhythmias. Use of synchronized capacitor discharge. JAMA. 1962;182:548–555.

    PubMed  CAS  Google Scholar 

  96. Lown B, Neuman J, Amarasingham R, Berkovits BV. Comparison of alternating current with direct electroshock across the closed chest. Am J Cardiol. 1962;10:223–233.

    PubMed  CAS  Google Scholar 

  97. Chattipakorn N, Banville I, Gray RA, Ideker RE. Mechanism of ventricular defibrillation for near-defibrillation threshold shocks: a whole-heart optical mapping study in swine. Circulation. 2001;104:1313–1319.

    PubMed  CAS  Google Scholar 

  98. Chen PS, Shibata N, Dixon EG, et al. Activation during ventricular defibrillation in open-chest dogs. Evidence of complete cessation and regeneration of ventricular fibrillation after unsuccessful shocks. J Clin Invest. 1986;77:810–823.

    PubMed  CAS  Google Scholar 

  99. Zhou X, Daubert JP, Wolf PD, et al. Epicardial mapping of ventricular defibrillation with monophasic and biphasic shocks in dogs. Circ Res. 1993;72:145–160.

    PubMed  CAS  Google Scholar 

  100. Valenzuela TD, Roe DJ, Cretin S, et al. Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation. 1997;96:3308–3313.

    PubMed  CAS  Google Scholar 

  101. Waalewijn RA, de Vos R, Tijssen JGP, Koster RW. Survival models for out-of-hospital cardiopulmonary resuscitation from the perspectives of the bystander, the first responder, and the paramedic. Resuscitation. 2001;51:113–122.

    PubMed  CAS  Google Scholar 

  102. Public Access Defibrillation Trial Investigators. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med. 2004;351:637–646.

    Google Scholar 

  103. Van Alem AP, Vrenken RH, de Vos R, et al. Use of automated external defibrillator by first responders in out of hospital cardiac arrest: prospective controlled trial. BMJ. 2003;327:1312–1315.

    PubMed  Google Scholar 

  104. Grubb NR, Cuthbert D, Cawood P, et al. Effect of DC shock on serum levels of total creatine kinase, MB-creatine kinase mass and troponin T. Resuscitation. 1998;36:193–199.

    PubMed  CAS  Google Scholar 

  105. Skulec R, Belohlavek J, Kovarnik T, et al. Serum cardiac markers response to biphasic and monophasic electrical cardioversion for supraventricular tachyarrhythmia – a randomised study. Resuscitation. 2006;70:423–431.

    PubMed  Google Scholar 

  106. Ambler JJS, Deakin CD. A randomised controlled trial of the effect of biphasic or monophasic waveform on the incidence and severity of cutaneous burns following external direct current cardioversion. Resuscitation. 2006;71:293–300.

    PubMed  Google Scholar 

  107. Pagan-Carlo LA, Stone MS, Kerber RE. Nature and determinants of skin “burns” after transthoracic cardioversion. Am J Cardiol. 1997;79:689–691.

    PubMed  CAS  Google Scholar 

  108. Kudenchuk PJ, Cobb LA, Copass MK, et al. Transthoracic incremental monophasic versus biphasic defibrillation by emergency responders (TIMBER): a randomized comparison of monophasic with biphasic waveform ascending energy defibrillation for the resuscitation of out-of-hospital cardiac arrest due to ventricular fibrillation. Circulation. 2006;114:2010–2018.

    PubMed  Google Scholar 

  109. Martens PR, Russell JK, Wolcke B, et al. Optimal response to cardiac arrest study: defibrillation waveform effects. Resuscitation. 2001;49:233–243.

    PubMed  CAS  Google Scholar 

  110. Morrison LJ, Dorian P, Long J, et al. Out-of-hospital cardiac arrest rectilinear biphasic to monophasic damped sine defibrillation waveforms with advanced life support intervention trial (ORBIT). Resuscitation. 2005;66:149–157.

    PubMed  Google Scholar 

  111. Schneider T, Martens PR, Paschen H, et al. Multicenter, randomized, controlled trial of 150-J biphasic shocks compared with 200- to 360-J monophasic shocks in the resuscitation of out-of-hospital cardiac arrest victims. Circulation. 2000;102:1780–1787.

    PubMed  CAS  Google Scholar 

  112. Van Alem AP, Chapman FW, Lank P, et al. A prospective, randomised and blinded comparison of first shock success of monophasic and biphasic waveforms in out-of-hospital cardiac arrest. Resuscitation. 2003;58:17–24.

    PubMed  Google Scholar 

  113. Faddy SC, Powell J, Craig JC. Biphasic and monophasic shocks for transthoracic defibrillation: a meta analysis of randomised controlled trials. Resuscitation. 2003;58:9–16.

    PubMed  Google Scholar 

  114. Kern KB, Hilwig R, Ewy GA. Retrograde coronary blood flow during cardiopulmonary resuscitation in swine: intracoronary Doppler evaluation. Am Heart J. 1994;128:490–499.

    PubMed  CAS  Google Scholar 

  115. Michael JR, Guerci AD, Koehler RC, et al. Mechanisms by which epinephrine augments cerebral and myocardial perfusion during cardiopulmonary resuscitation in dogs. Circulation. 1984;69:822–835.

    PubMed  CAS  Google Scholar 

  116. Otto CW, Yakaitis RW, Blitt CD. Mechanism of action of epinephrine in resuscitation from asphyxial arrest. Crit Care Med. 1981;9:321–324.

    PubMed  CAS  Google Scholar 

  117. Lindner KH, Ahnefeld FW. Comparison of epinephrine and norepinephrine in the treatment of asphyxial or fibrillatory cardiac arrest in a porcine model. Crit Care Med. 1989;17:437–441.

    PubMed  CAS  Google Scholar 

  118. Neumar RW, Bircher NG, Sim KM, et al. Epinephrine and sodium bicarbonate during CPR following asphyxial cardiac arrest in rats. Resuscitation. 1995;29:249–263.

    PubMed  CAS  Google Scholar 

  119. Popp E, Vogel P, Teschendorf P, Böttiger BW. Vasopressors are essential during cardiopulmonary resuscitation in rats: is vasopressin superior to adrenaline? Resuscitation. 2007;72:137–144.

    PubMed  CAS  Google Scholar 

  120. Ditchey RV, Lindenfeld J. Failure of epinephrine to improve the balance between myocardial oxygen supply and demand during closed-chest resuscitation in dogs. Circulation. 1988;78:382–389.

    PubMed  CAS  Google Scholar 

  121. Lindner KH, Ahnefeld FW, Schuermann W, Bowdler IM. Epinephrine and norepinephrine in cardiopulmonary resuscitation. Effects on myocardial oxygen delivery and consumption. Chest. 1990;97:1458–1462.

    PubMed  CAS  Google Scholar 

  122. Aung K, Htay T. Vasopressin for cardiac arrest: a systematic review and meta-analysis. Arch Intern Med. 2005;165:17–24.

    PubMed  CAS  Google Scholar 

  123. Callaham M, Madsen CD, Barton CW, et al. A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard-dose epinephrine in prehospital cardiac arrest. JAMA. 1992;268:2667–2672.

    PubMed  CAS  Google Scholar 

  124. Vandycke C, Martens P. High dose versus standard dose epinephrine in cardiac arrest – a meta-analysis. Resuscitation. 2000;45:161–166.

    PubMed  CAS  Google Scholar 

  125. Clemo HF, Wood MA, Gilligan DM, Ellenbogen KA. Intravenous amiodarone for acute heart rate control in the critically ill patient with atrial tachyarrhythmias. Am J Cardiol. 1998;81:594–598.

    PubMed  CAS  Google Scholar 

  126. Levine JH, Massumi A, Scheinman MM, et al. Intravenous amiodarone for recurrent sustained hypotensive ventricular tachyarrhythmias. J Am Coll Cardiol. 1996;27:67–75.

    PubMed  CAS  Google Scholar 

  127. Dorian P, Cass D, Schwartz B, et al. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002;346:884–890.

    PubMed  CAS  Google Scholar 

  128. Kudenchuk PJ, Cobb LA, Copass MK, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med. 1999;341:871–878.

    PubMed  CAS  Google Scholar 

  129. Pollak PT, Wee V, Al-Hazmi A, et al. The use of amiodarone for in-hospital cardiac arrest at two tertiary care centres. Can J Cardiol. 2006;22:199–202.

    PubMed  CAS  Google Scholar 

  130. Rea RS, Kane-Gill SL, Rudis MI, et al. Comparing intravenous amiodarone or lidocaine, or both, outcomes for inpatients with pulseless ventricular arrhythmias. Crit Care Med. 2006;34:1617–1623.

    PubMed  CAS  Google Scholar 

  131. Baraka A, Ayoub C, Kawkabani N. Magnesium therapy for refractory ventricular fibrillation. J Cardiothorac Vasc Anesth. 2000;14:196–199.

    PubMed  CAS  Google Scholar 

  132. Tobey RC, Birnbaum GA, Allegra JR, et al. Successful resuscitation and neurologic recovery from refractory ventricular fibrillation after magnesium sulfate administration. Ann Emerg Med. 1992;21:92–96.

    PubMed  CAS  Google Scholar 

  133. Fatovich DM, Prentice DA, Dobb GJ. Magnesium in cardiac arrest (the MAGIC trial). Resuscitation. 1997;35:237–241.

    PubMed  CAS  Google Scholar 

  134. Thel MC, Armstrong AL, McNulty SE, et al. Randomised trial of magnesium in in-hospital cardiac arrest. Lancet. 1997;350:1272–1276.

    PubMed  CAS  Google Scholar 

  135. Allegra J, Lavery R, Cody R, et al. Magnesium sulfate in the treatment of refractory ventricular fibrillation in the prehospital setting. Resuscitation. 2001;49:245–249.

    PubMed  CAS  Google Scholar 

  136. Hassan TB, Jagger C, Barnett DB. A randomised trial to investigate the efficacy of magnesium sulphate for refractory ventricular fibrillation. Emerg Med J. 2002;19:57–62.

    PubMed  CAS  Google Scholar 

  137. Perticone F, Adinolfi L, Bonaduce D. Efficacy of magnesium sulfate in the treatment of torsade de pointes. Am Heart J. 1986;112:847–849.

    PubMed  CAS  Google Scholar 

  138. Tzivoni D, Banai S, Schuger C, et al. Treatment of torsade de pointes with magnesium sulfate. Circulation. 1988;77:392–397.

    PubMed  CAS  Google Scholar 

  139. Bailie DS, Inoue H, Kaseda S, et al. Magnesium suppression of early afterdepolarizations and ventricular tachyarrhythmias induced by cesium in dogs. Circulation. 1988;77:1395–1402.

    PubMed  CAS  Google Scholar 

  140. Brown DC, Lewis AJ, Criley JM. Asystole and its treatment: the possible role of the parasympathetic nervous system in cardiac arrest. JACEP. 1979;8:448–452.

    PubMed  CAS  Google Scholar 

  141. Gupta K, Lichstein E, Chadda KD. Transient atrioventricular standstill. Etiology and management. JAMA. 1975;234:1038–1042.

    PubMed  CAS  Google Scholar 

  142. Coon GA, Clinton JE, Ruiz E. Use of atropine for brady-asystolic prehospital cardiac arrest. Ann Emerg Med. 1981;10:462–467.

    PubMed  CAS  Google Scholar 

  143. Ornato JP, Gonzales ER, Morkunas AR, et al. Treatment of presumed asystole during pre-hospital cardiac arrest: superiority of electrical countershock. Am J Emerg Med. 1985;3:395–399.

    PubMed  CAS  Google Scholar 

  144. Stueven HA, Tonsfeldt DJ, Thompson BM, et al. Atropine in asystole: human studies. Ann Emerg Med. 1984;13:815–817.

    PubMed  CAS  Google Scholar 

  145. Engdahl J, Bång A, Lindqvist J, Herlitz J. Can we define patients with no and those with some chance of survival when found in asystole out of hospital? Am J Cardiol. 2000;86:610–614.

    PubMed  CAS  Google Scholar 

  146. Van Walraven C, Stiell IG, Wells GA, et al. Do advanced cardiac life support drugs increase resuscitation rates from in-hospital cardiac arrest? Ann Emerg Med. 1998;32:544–553.

    PubMed  Google Scholar 

  147. Chamberlain DA, Turner P, Sneddon JM. Effects of atropine on heart-rate in healthy man. Lancet. 1967;290:12–15.

    Google Scholar 

  148. Adrogué HJ, Rashad MN, Gorin AB, et al. Assessing acid-base status in circulatory failure. Differences between arterial and central venous blood. N Engl J Med. 1989;320:1312–1316.

    PubMed  Google Scholar 

  149. Weil MH, Rackow EC, Trevino R, et al. Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. N Engl J Med. 1986;315:153–156.

    PubMed  CAS  Google Scholar 

  150. Dybvik T, Strand T, Steen PA. Buffer therapy during out-of-hospital cardiopulmonary resuscitation. Resuscitation. 1995;29:89–95.

    PubMed  CAS  Google Scholar 

  151. Ritter JM, Doktor HS, Benjamin N. Paradoxical effect of bicarbonate on cytoplasmic pH. Lancet. 1990;335:1243–1246.

    PubMed  CAS  Google Scholar 

  152. Morrison LJ, Verbeek PR, McDonald AC, et al. Mortality and prehospital thrombolysis for acute myocardial infarction: a meta-analysis. JAMA. 2000;283:2686–2692.

    PubMed  CAS  Google Scholar 

  153. Wan S, Quinlan DJ, Agnelli G, Eikelboom JW. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation. 2004;110:744–749.

    PubMed  CAS  Google Scholar 

  154. Fischer M, Böttiger BW, Popov-Cenic S, Hossmann KA. Thrombolysis using plasminogen activator and heparin reduces cerebral no-reflow after resuscitation from cardiac arrest: an experimental study in the cat. Intensive Care Med. 1996;22(11):1214–1223.

    PubMed  CAS  Google Scholar 

  155. Lin SR. The effect of dextran and streptokinase on cerebral function and blood flow after cardiac arrest. An experimental study on the dog. Neuroradiology. 1978;16:340–342.

    PubMed  CAS  Google Scholar 

  156. Gramann J, Lange-Braun P, Bodemann T, Hochrein H. Der Einsatz von Thrombolytika in der Reanimation als Ultima ratio zur Überwindung des akuten Herztodes. Intensiv und Notfallbehandlung. 1991;16:134–137.

    Google Scholar 

  157. Janata K, Holzer M, Kürkciyan I, et al. Major bleeding complications in cardiopulmonary resuscitation: the place of thrombolytic therapy in cardiac arrest due to massive pulmonary embolism. Resuscitation. 2003;57:49–55.

    PubMed  Google Scholar 

  158. Kürkciyan I, Meron G, Sterz F, et al. Pulmonary embolism as a cause of cardiac arrest: presentation and outcome. Arch Intern Med. 2000;160:1529–1535.

    PubMed  Google Scholar 

  159. Ruiz-Bailén M, Aguayo-de-Hoyos E, Serrano-Córcoles MC, et al. Thrombolysis with recombinant tissue plasminogen activator during cardiopulmonary resuscitation in fulminant pulmonary embolism. A case series. Resuscitation. 2001;51:97–101.

    PubMed  Google Scholar 

  160. Abu-Laban RB, Christenson JM, Innes GD, et al. Tissue plasminogen activator in cardiac arrest with pulseless electrical activity. N Engl J Med. 2002;346:1522–1528.

    PubMed  CAS  Google Scholar 

  161. Fatovich DM, Dobb GJ, Clugston RA. A pilot randomised trial of thrombolysis in cardiac arrest (the TICA trial). Resuscitation. 2004;61:309–313.

    PubMed  Google Scholar 

  162. Herweling A, Karmrodt J, Stepniak A, et al. A novel technique to follow fast PaO2 variations during experimental CPR. Resuscitation. 2005;65:71–78.

    PubMed  Google Scholar 

  163. Tucker KJ, Idris AH, Wenzel V, Orban DJ. Changes in arterial and mixed venous blood gases during untreated ventricular fibrillation and cardiopulmonary resuscitation. Resuscitation. 1994;28:137–141.

    PubMed  CAS  Google Scholar 

  164. Glaeser PW, Hellmich TR, Szewczuga D, et al. Five-year experience in prehospital intraosseous infusions in children and adults. Ann Emerg Med. 1993;22:1119–1124.

    PubMed  CAS  Google Scholar 

  165. Orlowski JP, Porembka DT, Gallagher JM, et al. Comparison study of intraosseous, central intravenous, and peripheral intravenous infusions of emergency drugs. Am J Dis Child. 1990;144:112–117.

    PubMed  CAS  Google Scholar 

  166. Befeler B. Mechanical stimulation of the heart: its therapeutic value in tachyarrhythmias. Chest. 1978;73:832–838.

    PubMed  CAS  Google Scholar 

  167. Caldwell G, Millar G, Quinn E, et al. Simple mechanical methods for cardioversion: defence of the precordial thump and cough version. Br Med J. 1985;291:627–630.

    CAS  Google Scholar 

  168. Morgera T, Baldi N, Chersevani D, et al. Chest thump and ventricular tachycardia. Pacing Clin Electrophysiol. 1979;2:69–75.

    PubMed  CAS  Google Scholar 

  169. Cobb LA, Fahrenbruch CE, Walsh TR, et al. Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation. JAMA. 1999;281:1182–1188.

    PubMed  CAS  Google Scholar 

  170. Wik L, Hansen TB, Fylling F, et al. Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital ventricular fibrillation: a randomized trial. JAMA. 2003;289:1389–1395.

    PubMed  Google Scholar 

  171. Rea TD, Shah S, Kudenchuk PJ, et al. Automated external defibrillators: to what extent does the algorithm delay CPR? Ann Emerg Med. 2005;46:132–141.

    PubMed  Google Scholar 

  172. Hess EP, White RD. Ventricular fibrillation is not provoked by chest compression during post-shock organized rhythms in out-of-hospital cardiac arrest. Resuscitation. 2005;66:7–11.

    PubMed  Google Scholar 

  173. Buunk G, van der Hoeven JG, Meinders AE. Cerebrovascular reactivity in comatose patients resuscitated from a cardiac arrest. Stroke. 1997;28:1569–1573.

    PubMed  CAS  Google Scholar 

  174. Langhelle A, Tyvold SS, Lexow K, et al. In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway. Resuscitation. 2003;56:247–263.

    PubMed  CAS  Google Scholar 

  175. Müllner M, Sterz F, Binder M, et al. Blood glucose concentration after cardiopulmonary resuscitation influences functional neurological recovery in human cardiac arrest survivors. J Cereb Blood Flow Metab. 1997;17:430–436.

    PubMed  Google Scholar 

  176. Sundgreen C, Larsen FS, Herzog TM, et al. Autoregulation of cerebral blood flow in patients resuscitated from cardiac arrest. Stroke. 2001;32:128–132.

    PubMed  CAS  Google Scholar 

  177. Sterz F, Leonov Y, Safar P, et al. Hypertension with or without hemodilution after cardiac arrest in dogs. Stroke. 1990;21:1178–1184.

    PubMed  CAS  Google Scholar 

  178. Capes SE, Hunt D, Malmberg K, et al. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001;32:2426–2432.

    PubMed  CAS  Google Scholar 

  179. Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359–1367.

    PubMed  Google Scholar 

  180. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557–563.

    PubMed  Google Scholar 

  181. Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–556.

    Google Scholar 

  182. Holzer M, Bernard SA, Hachimi-Idrissi S, et al. Hypothermia for neuroprotection after cardiac arrest: systematic review and indivi­dual patient data meta-analysis. Crit Care Med. 2005;33:414–418.

    PubMed  Google Scholar 

  183. Holzer M, Müllner M, Sterz F, et al. Efficacy and safety of endovascular cooling after cardiac arrest: cohort study and Bayesian approach. Stroke. 2006;37:1792–1797.

    PubMed  Google Scholar 

  184. Steinberg GK, Ogilvy CS, Shuer LM, et al. Comparison of endovascular and surface cooling during unruptured cerebral aneurysm repair. Neurosurgery. 2004;55:307–314.

    PubMed  Google Scholar 

  185. Bernard S, Buist M, Monteiro O, Smith K. Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation. 2003;56:9–13.

    PubMed  Google Scholar 

  186. Virkkunen I, Yli-Hankala A, Silfvast T. Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer’s solution: a pilot study. Resuscitation. 2004;62:299–302.

    PubMed  Google Scholar 

  187. Sessler DI. Mild perioperative hypothermia. N Engl J Med. 1997;336:1730–1737.

    PubMed  CAS  Google Scholar 

  188. Kranke P, Eberhart LH, Roewer N, Tramèr MR. Pharmacological treatment of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesth Analg. 2002;94:453–460.

    PubMed  CAS  Google Scholar 

  189. Coimbra C, Boris-Möller F, Drake M, Wieloch T. Diminished neuronal damage in the rat brain by late treatment with the antipyretic drug dipyrone or cooling following cerebral ischemia. Acta Neuropathol. 1996;92:447–453.

    PubMed  CAS  Google Scholar 

  190. Booth CM, Boone RH, Tomlinson G, Detsky AS. Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA. 2004;291:870–879.

    PubMed  CAS  Google Scholar 

  191. Zandbergen EGJ, de Haan RJ, Stoutenbeek CP, et al. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet. 1998;352:1808–1812.

    PubMed  CAS  Google Scholar 

  192. Zandbergen EGJ, de Haan RJ, Hijdra A. Systematic review of prediction of poor outcome in anoxic-ischaemic coma with biochemical markers of brain damage. Intensive Care Med. 2001;27:1661–1667.

    PubMed  CAS  Google Scholar 

  193. Torbey MT, Selim M, Knorr J, et al. Quantitative analysis of the loss of distinction between gray and white matter in comatose patients after cardiac arrest. Stroke. 2000;31:2163–2167.

    PubMed  CAS  Google Scholar 

  194. Pell JP, Sirel JM, Marsden AK, et al. Presentation, management, and outcome of out of hospital cardiopulmonary arrest: comparison by underlying aetiology. Heart. 2003;89:839–842.

    PubMed  CAS  Google Scholar 

  195. Zipes DP, Wellens HJJ. Sudden cardiac death. Circulation. 1998;98:2334–2351.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Postoperative Intensive Care Medicine, University of Cologne, Cologne, Germany

    Andreas Schneider & Erik Popp

  2. Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany

    Bernd W. Böttiger

Authors
  1. Andreas Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erik Popp
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bernd W. Böttiger
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Surgical Critical Care Division of Surgery, The Lahey Clinic Medical Center, Burlington, MA, USA

    John M. O’Donnell (Director, Surgical Intensive Care Unit Chairman) (Director, Surgical Intensive Care Unit Chairman)

  2. University Hospital Intensive Care Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Flávio E. Nácul

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Schneider, A., Popp, E., Böttiger, B.W. (2010). Cardiopulmonary Resuscitation. In: O’Donnell, J.M., Nácul, F.E. (eds) Surgical Intensive Care Medicine. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-77893-8_12

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-77893-8_12

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-387-77892-1

  • Online ISBN: 978-0-387-77893-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation