Book Review

Cardiac Arrest: The science and practice of resuscitation medicine

N Engl J Med 1997; 336:383-384January 30, 1997

Article

Cardiac Arrest: The science and practice of resuscitation medicine
Edited by Norman A. Paradis, Henry R. Halperin, and Richard M. Nowak. 981 pp., illustrated. Baltimore, Williams and Wilkins, 1996. $139. ISBN: 0-683-06765-6

The aims of Cardiac Arrest: The Science and Practice of Resuscitation Medicine are to delineate the state of the art in the treatment of cardiopulmonary arrest, to complement the basic and advanced cardiac life-support guidelines of the American Heart Association, and to analyze critically material not readily available elsewhere. This unique and definitive textbook for clinicians largely succeeds in reaching these goals.

The book is divided into seven sections: an introduction, “Basic Science,” “The Pathophysiology of Global Ischemia and Reperfusion,” “Therapy of Sudden Death,” “Special Circumstances,” “Postresuscitation Disease,” and “The Future.” The qualifications of the 96 contributors, who include virtually all the major researchers in this field, are exemplary. Each chapter was written by key researchers who have helped define the field; the result is a discussion that is authoritative, well anchored in science, and often placed in better context than are the advanced cardiac life-support guidelines.

The material in many of the chapters will be familiar to those who have studied advanced cardiac life support, but Cardiac Arrest treats it in a more sophisticated way. Other chapters fill important gaps in the advanced cardiac life-support material or offer stronger discussions than are available elsewhere. For example, the fascinating chapter on the history of cardiopulmonary resuscitation has unusual depth and detail. An equally excellent chapter describes the generally misunderstood process of developing a consensus for the advanced cardiac life-support guidelines. These two chapters, which alone make the book worth purchasing, help explain some peculiarities of the present guidelines that many clinicians could find puzzling. The chapter titled “Diagnosis during Cardiac Arrest: Real-Time Monitoring” covers a topic of great interest to clinicians that is often omitted in other textbooks. It provides a sound theoretical and scientific foundation as well as a full appreciation of clinical realities and priorities. Two other chapters, “Vasopressor Therapy during Cardiac Arrest” and “Acid-Base Considerations during and after Resuscitation,” are not only much more detailed and convincing than most treatments of these topics, but also considerably more lucid.

This is a very strong first edition. However, one could wish for more coverage in some areas. The chapter on methods provides an excellent discussion of physical measurements in research on cardiopulmonary resuscitation, but it does not deal with the limitations of the studies in animals that form the basis of most current therapy for cardiac arrest — for example, the use of young, healthy animals with normal hearts and patent vessels to develop treatments for elderly humans with stenotic vessels and diseased myocardia. Similarly helpful would be a discussion of the limitations of clinical trials, such as the fact that chest compression and ventilation are uncontrolled and unmeasured or the difficulties of blinding studies that use mechanical interventions. The paucity of randomized controlled trials in a field in which some might say that clinical guidelines have driven research, rather than vice versa, would also make an interesting topic. Fuller treatment of these issues might help explain why, 30 years after being introduced, many therapies are unproved and probably ineffective.

The excellent chapter titled “Postresuscitation Prognostication and Declaration of Brain Death” focuses almost exclusively on predicting short-term outcomes in initially comatose patients but does not discuss the neurologic outcomes in patients who awake within minutes of cardiac arrest and who account for most of the long-term survivors with supposedly normal neurologic function. It would be helpful to know about the applications and limitations of methods for the neurologic evaluation of an awake survivor of cardiac arrest. Discussion of when to discontinue resuscitation efforts is limited to occasional brief paragraphs in various chapters. The only index entry for “ethics” refers to a few paragraphs in the chapter on resuscitation of the elderly.

This excellent book, the first of its kind in the field of cardiac arrest, provides a balance of theoretical and practical information. It achieves a level of authority and sophistication well beyond that of the advanced cardiac life-support guidelines and will be of considerable use to anyone practicing or teaching clinical resuscitation.

Michael Callaham, M.D.
University of California, San Francisco, San Francisco, CA 94143