A new proposal of CPR based on coronary perfusion pressure.

Closed chest massage and tracheal intubation are not enough. The 70% success rate promised by Kouwenhoven 31 years ago is not realised. Coronary perfusion pressure is the main goal. To achieve this a proposal of a combined new CPR is advocated which encompass the following items besides closed chest massage and tracheal intubation: (a) use of high dose methoxamine (instead of epinephrine), (b) use of continuous abdominal pressure (instead of intermittent pressure), (c) unloading the pump, which means no use of any intravenous fluids, and (d) intracardiac injection of medications until restarting of spontaneous circulation.