Direct mechanical heart massage.
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A 27-year-old woman sustained a massive pulmonary embolism (cause unknown) with circulatory arrest. She was intubated and ventilated while external cardiac massage was performed and urokinase was infused (1.5 X 10(6) U/h). These resuscitative measures were continued while she was transferred by helicopter to the nearest cardiothoracic surgical centre, 40 km away. Thrombectomy was successfully accomplished under extracorporeal circulation after (from its onset) 90 minutes of external cardiac massage. No neurological or other sequelae occurred. This case demonstrates that early and continuous resuscitative measures in a general hospital, followed by rapid transfer to a cardiothoracic surgical centre with immediate operation, can achieve a successful outcome.
60 persons were asked to perform external cardiac massage on two phantoms by the arm-hand and leg-heel method respectively. This leg-heel method does not offer any special advantages over the arm-hand technique if the helper is tired; nor is it easier to learn. Because of its general applicability the latter method should remain the standard technique taught, especially as laymen are apt to become confused by a multiplicity of methods.
A delayed rupture of the liver after resuscitation is reported. In the case of a 27-year-old woman, pulmonary embolism was followed by asystolia, which was remedied by external cardiac massage. This procedure caused ruptures of the liver, which first led to the formation of a subcapsular hematoma and 5 1/2 hours later, due to a secondary rupture of the capsule, led to internal bleeding and death. Degenerative changes of the parenchyma cells in the vicinity of the rupture were recognized, as well as fibrin separations on the detached Glisson's capsule, as signs of a survival period of several hours. Histological investigation of the lungs revealed a hepatocellular embolism and--in the absence of rib or sternum fractures--fat and bone-marrow embolisms. The morphological findings are discussed with reference to pertinent reports in the literature.
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A method permitting to define the efficiency of devices designed for direct cardiomassage on a special hydrodynamic stand is given. The results are presented, obtained with the variation of the main functional parameters which ensure maximum capacity of the device. Factors influencing the cardiomassage efficiency were determined. The devices investigated were claimed to provide the capacity sufficient for entire or partial substitution of the cardiac pumping function.
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Heart rate and blood pressure responses during and after carotid sinus massage were examined in 66 patients just before coronary angiography. A significant relationship was found between heart rate and blood pressure responses and (1) angina pectoris class, (2) total coronary artery disease score and (3) presence of high-grade (> 90%) stenosis of any of the three major coronary arteries. Only patients with contraction abnormalities of the anterolateral left ventricular region had greater cardionhibitory responses than patients with normal left ventricular angiograms. Among patients with normal left ventricular angiograms, those with more than 50% stenosis of one or more vessels had significantly (p < 0.01) greater responses than those with no or minimal coronary artery disease. All 21 hypersensitive (asystole longer than 3 seconds) patients had significant multivessel coronary artery stenoses or single-vessel high-grade stenosis (greater than or equal to 90%) proximal to the atrioventricular nodal artery. None of the 11 patients with normal coronary arteries had an exaggerated response to carotid sinus massage. These data support the association of an exaggerated response to carotid sinus massage in the presence of symptomatic coronary artery disease and suggest that the magnitude of response is influenced by the severity of the disease.
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Manual vibratory massage is part of the preventive physiotherapeutic activities performed in intensive care units. The vibratory massage can be performed manually or as electrovibratory massage. The manual massage is a fast rhythmical vibration performed by the arm and shoulder muscles of the masseur and transferred to the patient's thorax by the hand. The hand of the masseur has to achieve a tremor with a frequency of 8 to 11 tremors/s. The aim of the pilot study was to examine the influence of manual vibratory massage on the pulmonary function of postoperative patients who were receiving mechanical ventilation, with special interest being focused on pulmonary ventilation and perfusion and cerebral blood flow velocity. Manual vibratory massage was performed postoperatively in the intensive care unit on eight patients: three patients had undergone heart transplantation, three had undergone lung transplantation, and two had undergone coronary artery bypass grafting (mean age, 53.6+/-8 yr). With the aid of continuous monitoring, we examined the changes of the respiration parameters and the cerebral blood flow velocity (measured by transcranial Doppler sonography). The vibratory massage was performed with a frequency of 8 to 10 vibrations/s for 15 min, 7.5 min on each side of the thorax, starting from the lower costal arch and progressing to the upper thoracic aperture. For 10 min before, during, and 10 min after the massage, the parameters of peripheral oxygen saturation, central venous pressure, mean arterial pressure, heart rate, lung resistance and compliance, tidal volume, respiration rate, and cerebral blood flow velocity were recorded at 2-min intervals. Moreover, before and after vibratory massage, arterial blood gases were determined. In four of the eight patients, it was possible to determine pulmonary arterial pressure, pulmonary capillary wedge pressure, as well as pulmonary vascular resistance. During the vibratory massage, we could prove a significant increase of the mean tidal volume by 30% (P = 0.008). The percutaneous oxygen saturation significantly increased also, from 92 to 93.6% (P = 0.002). Central venous pressure significantly decreased by 11% (P = 0.04), and pulmonary vessel resistance was reduced by 18.3% (P = 0.001). The pulmonary resistance decreased from 10.5 to 9.2 H2O/l/s (P < 0.05) by the end of the observation period. Cerebral blood flow velocity showed no significant change. Vibratory massage seems to improve pulmonary mechanism and perfusion, thus, reducing ventilation perfusion mismatch and increasing oxygen saturation.
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