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Featured Clinical Reviews

March 19, 2003

Priming the Pump—Can Delaying Defibrillation Improve Survival After Sudden Cardiac Death?

Author Affiliations

Author Affiliation: Department of Emergency Medicine, University of Arizona, Tucson.

JAMA. 2003;289(11):1434-1436. doi:10.1001/jama.289.11.1434

Few medical phenomena engage the popular and medical imaginations as completely as resuscitation of the patient with out-of-hospital cardiac arrest. Application of defibrillator paddles to the chest wall, administering an electrical countershock, and restoring cardiac rhythm and circulation is depicted in films and on television as a dramatic, often lifesaving event.

The medical reality, however, is that survival after out-of-hospital cardiac arrest is uncommon. Despite decades of research and advances in resuscitation, less than 5% of patients survive out-of-hospital cardiac arrest in the United States.1,2 These outcomes have prompted the suggestion that new approaches for treatment of cardiac arrest due to ventricular fibrillation should be developed.3 In this issue of THE JOURNAL, Wik and colleagues4 report the results of a prospective, randomized comparison of manual cardiopulmonary resuscitation (CPR) prior to defibrillation vs traditional immediate defibrillation in patients with out-of-hospital cardiac arrest.

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