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Introduction: Bystander cardiopulmonary resuscitation (CPR) has been shown to significantly improve outcome in sudden cardiac arrest in children. In view of this, most emergency medicine services deliver telephone instructions for carrying out CPR to laypeople who call the emergency services. Little is known as to whether laypeople carrying out these instructions deliver effective CPR., Methods: Adult volunteers who had no previous experience of CPR were recruited. They were presented with a scenario and asked to perform CPR for 3 min on a training manikin according to the instructions they were given by telephone. Tidal volume, compression rate and depth, time to the beginning of CPR and hand positioning were recorded., Results: Fifty-five volunteers were recruited; three were excluded (two had previous CPR training and one refused to perform CPR). None of the subjects identified correctly that the manikin was not breathing and achieved a level of CPR performance that was consistent with all of the current guidelines. Median tidal volume of rescue breaths was 38 mL. Only 23% of subjects delivered rescue breaths of optimal volume (40-50 mL) and 23% delivered no effective breaths at all. Chest compressions were performed at a median rate of 95 min(-1) with 37% delivering compressions at the optimum rate of 90-110 min(-1)., Conclusion: None of our volunteers performed telephone-CPR at a level consistent with current guidelines. Further investigation is necessary to determine whether the instructions can be improved to optimise CPR performance.

We describe two patients who both suffered a cardiac arrest whilst maintained on an intra-aortic balloon pump. In an attempt to improve coronary and cerebral blood flow during cardiopulmonary resuscitation, the intra-aortic balloon was inflated to occlude the descending aorta and preferentially direct blood to the cerebral and coronary circulation. In case 1, mean radial artery pressure rose from 71/14 mmHg (mean = 33 mmHg) to 92/24 mmHg (mean = 47 mmHg). Diastolic right atrial pressure was 16 mmHg both with the balloon deflated and inflated. In patient 2, mean radial artery pressure rose from 48/21 mmHg (mean = 25 mmHg) to 62/26 mmHg (mean = 36 mmHg). Right atrial pressure was 90/6 mmHg (mean 34 mmHg) with the balloon deflated and 104/8 mmHg (mean = 40 mmHg) with the balloon inflated. Coronary artery perfusion pressure in case 1 increased from -2 to 8 mmHg and in case 2 increased from 15 to 18 mmHg. These results suggest that occlusion of the descending aorta during cardiac massage may improve coronary and cerebral perfusion pressures. Animal studies are consistent with these findings and show that aortic occlusion may significantly improve outcome from cardiac arrest.