PURPOSE OF REVIEW: To describe a resuscitation protocol for out-of-hospital cardiac arrest designed for healthcare professionals that demands more from rescuers than does conventional cardiopulmonary resuscitation. It was introduced with the aim of improving survival that has remained disappointingly poor worldwide. RECENT FINDINGS: Survival to hospital discharge, that could be measured accurately in one city, improved appreciably with the use of the novel protocol. The implications are discussed in relation to the scientific background and relevant literature. SUMMARY: Uniform resuscitation protocols for lay and for professional use may not be appropriate. Only randomized trials can indicate the potential value of this challenge to conventional wisdom.