When recommended guidelines are not enough: Is there something more to try ?: Review article

AIM: To show that in some cases, when implementation of the recommended CPR guidelines fail, there are still useful interventions that can save lives of the cardiac arrest patients. MATERIALS AND METHODS: Authors conducted review of the available literature, (Cochrane library, MEDLINE, Pub Med etc.), with special attention on articles published by authors in Serbia and case reports. RESULTS: Authors intention is to show cases when transcutaneous pacing (TCP), thrombolytic treatment and aminophylline where used after all recommended CPR methods failed, leading to positive outcome of resuscitation attempts. In spite of discouraging results of the large studies about TCP in CPR, except in brady-asystolic cardiac arrest, there are some smaller studies and case reports where this intervention was successful and life saving for the patient. The same situation is considering aminophylline. There is no firm evidence of its usefulness in cardiac arrest. Knowing that aminophylline is adenosine antagonist and that adenosine is produced during ischemia and hypoxia, depressing the sinoatrial node, AV node and Hiss Purkinje fibers conduction, there is a potential space for aminophylline use in CPR. Significant number of randomized trials about thrombolytic treatment during CPR did not clearly show its usefulness and increased survival rates. CONCLUSION: Each case of cardiac arrest should be treated implementing the CPR recommendations accepted by ILCOR and national organizations. However, overall survival rate after cardiac arrest is still lower than expected. Authors are presenting the interventions used after all the protocols failed, leading to successful resuscitation in specific situations