Selective neurological recovery or dissociated cardiac death--to be or not to be--during cardiopulmonary resuscitation.

Of 111 victims of circulatory arrest, 93 (84%) retained or regained some brain function during the resuscitation process. Twenty-six of these (24%) did not have spontaneous circulation restored, and a further 18 (16%) were left in cardiogenic shock and died within 24 h. Bradyarrhythmia or asystole during the resuscitation efforts or prolonged resuscitative attempts beyond 20 min were related to the irreversible failure of heart pump function. Individuals developing either this type of 'dissociated cardiac death' or cardiogenic shock could not be identified prior to resuscitation by the cause of the arrest nor by the initial cardiac arrhythmia. 'Dissociated cardiac death' and cardiogenic shock are major problems in cardiopulmonary resuscitation. A code of practice is urgently needed.