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PubMed2006

Stanford type A acute aortic dissection caused by blunt trauma in a patient with situs inversus.

We report a case of Stanford type A acute aortic dissection caused by blunt trauma in a patient with situs inversus. A 57-year-old man was involved in an explosion accident. It was indicated that he had suffered Stanford type A acute aortic dissection, cardiac tamponade, and situs inversus by contrast enhanced computed tomography and echocardiography. With the introduction of anesthesia, he went into shock. An extracorporeal circuit was immediately introduced with heart massage. The ascending aorta was replaced with a prosthesis using cardiopulmonary bypass. The branches of the aortic arch were mirror-image reversed. The patient's general condition improved, and he was discharged from our department 3 weeks after the operation.

Aortic Dissection↗
PubMed1994

Cardiopulmonary resuscitation after thoracic surgery: echocardiographic observations.

We report echocardiographic observations during external chest compression in a patient with marked abnormalities in thoracic anatomy following emergency surgery of aortic arch aneurysm. Transesophageal echocardiography demonstrated direct right ventricular, aortic and left atrial compression, only minimal left ventricular compression and an open mitral valve during closed chest heart massage. Colour flow doppler demonstrated forward blood flow across the mitral valve and along the left ventricular outflow tract during the compression phase. Echocardiographic findings indicate that factors apart from simple cardiac pump mechanism contributed to blood flow during cardiopulmonary resuscitation (CPR) in this postoperative patient after a major thoracic surgical intervention.

Aortic Aneurysm, Thoracic↗
PubMed1984

Cardiopulmonary resuscitation research 1960-1984: discoveries and advances.

The 24-year history of cardiopulmonary resuscitation (CPR) can be divided into four eras. The first (1960-1962) was the era of serendipitous discovery and description of "closed-chest cardiac massage" by Kouwenhoven and colleagues. Closed-chest heart massage was combined with artificial ventilation, and became known as CPR. The second (1962-1968) was the era of skepticism, in which CPR was challenged by investigators whose observations of hemodynamics were not in concert with the proposed mechanism of blood flow. The equality of arterial and central venous pressures during chest compression seemingly belied the proposed mechanism of blood flow during CPR, and raised questions about the effectiveness of the technique. The third era (1968-1976) was one of acceptance and complacency. The effectiveness had become established through widespread use in coronary care units, catheterization laboratories, and prehospital emergency systems, and open-chest cardiac massage was completely supplanted by CPR in virtually every resuscitation effort. The current era (1976-present) is the era of rediscovery and refinement, beginning with the observation that blood flow and pressure can be generated during cardiac arrest by coughing ("cough CPR"), without actual compression of the chest or heart, and that augmentation of arterial pressure and carotid blood flow resulted from simultaneous compression and ventilation (SCV-CPR or "new CPR"). The current era has provided a new explanation of the mechanism of blood flow during CPR and alternative methods of maintaining perfusion during cardiac arrest.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

An apparatus for applying a mechanical massage to rat hearts inside a wide-bore NMR spectrometer.

A device for applying mechanical massage to the isolated perfused rat heart inside a wide-bore NMR spectrometer was developed. This device exerts a squeezing pressure on a fibrillating heart placed inside a NMR spectrometer without interfering with the NMR measurements. It appears that the apparatus is important for obtaining reliable results in the postischemic reperfusion period.

Animals↗
PubMed2004

Extracorporeal circulation in non-cardiac surgery.

Tradition and experience of cardiopulmonary bypass in the hand of cardiac surgeons Led to several spin-offs of this extracorporeal technique. Acute organ support is realized for situations of failing cardiac output, circulatory arrest respectively, of pulmonary failure and of drowning. Extracorporeal circulation is a promising adjunct to aim in better surgical technique and treatment in neurosurgery, thoracic aortic surgery, complex Lung resection, tumor surgery and procedures where safe organ perfusion must be ascertained. Chemotherapy and hyperthermia in limb carcinoma is highly successful if performed with the help of extracorporeal circulation. Progression in transcutaneous cannulation technique makes application of machinery easy and from operation facilities independent. Replacement of Long lasting periods of chest compression for heart massage is a future perspective if circulation is maintained by transcutaneously adapted miniaturized heart-lung-machine. Long lasting traumatizing mechanical ventilation of a severely diseased lung maybe replaced by extracorporeal lung assistance to give better chances for the lung to recover. Thoughts for these new interdisciplinary duties of cardio surgical units were discussed in the committee for the Symposium for the Future of Cardiac Surgery.

Cardiopulmonary Bypass↗
PubMed1979

[Direct cardiac massage in refractory heart arrest. 2 cases sucessfully treated in the coronary care unit].

The open chest, or direct cardiac massage may be indicate in instances where closed chest techniques are ineffective. Direct cardiac massage was successfully applied by us in two patients who failed to resuscitate with closed chest massage. The patients, an 49 year old man with acute myocardial infarction and an 53 year old man who had a history of previous myocardial infarction with subsequent development of a ventricular aneurysm, had ventricular fibrillation who not responded to closed chest cardiac massage and to repeated electrical countershocks. When the pupils became dilated the decision was made to open the chest and apply direct massage. After several minutes of manual cardiac compression a single D.C. countershock returned the heart to a normal sinus rhythm in each of the patients. Although the thoracotomy was performed outside the operating room, none of the complications of the open chest resuscitation occurred, such as intrathoracic infection, rupture of the heart, and postresuscitative bleeding. The first patient recovered from the infarction, has been discharged from the hospital and is alive and well after 5 months. The second patient has been discharged from the U.C.C. and is alive and well after 15 days.

Electric Countershock↗
PubMed1978

Transitory heart pacemaker for the prophylaxis of hypoxic cardiac standstill in cases of severe pulmonary insufficiency.

Patients with hypoxia due to severe pulmonary insufficiency show a tendency towards hypoxic cardiac arrest. Asystole can occur in patients during therapeutic and nursing measures such as endotracheal suction. Experience indicates that the hypoxic cardiac arrest is difficult to resuscitate. External heart massage also shows a variety of complications. We propose the appropriately timed and prophylactic use of a transitory heart pacemaker for patients with a tendency towards hypoxic cardiac arrest. Our results show that a transitory heart pacemaker is capable of producing heart contractions even in cases of the severest hypoxia, in which otherwise cardiac arrest already would have occurred. The subclavian vein is punctured, and the electrode is pushed into the right ventricle. The electrode tip is positioned accurately by means of X-ray examination, and also by monitoring the threshold of the stimulating current. We consider that the proposed method should be used in patients who would have an increased chance of survival as a result of the additional measure of using a transitory heart pacemaker in cases of pulmonary hypoxia. It would not be indicated in patients with unfavourable prognoses due to progressive changes in the lungs.

Aged↗
PubMed1975

[Complications of peridural anesthesia].

Peridural anesthesia is believed to be a complicated kind of analgesia yielding grave complications (syncope, apnoe, collapse, persistant and pronounced hypotension, nematomyelia, paraplegia of the lower extremities, Brown--Seguard syndrome and many others). This king od anesthesia is permissible only in an anesthesiological or reanimatological department. The frequency of complications depends on a level of injecting the anesthetic, patient's status and age. The former is the greater the higher the level of the peridural space puncture. To combat against complications occurring while using this kind of analgesia everything necessary for reanimation provision (intubation of the trachea, closed and open heart massage, etc.) should be ready at hand.

Aged↗
PubMed1991

[Gas embolism with cardiac arrest during hysteroscopy. A case report on 3 patients].

Hysteroscopy and laparoscopy are relatively non-invasive methods routinely employed in the investigation of infertility. The danger of air embolism during these procedures was recognized early, and carbon dioxide was substituted for air since it is more readily soluble in blood. In this report we describe 3 cases of circulatory collapse and cardiac arrest in healthy young women during routine hysteroscopy (out of a total of 62 patients during the period 1989-1990) which were most probably caused by massive carbon dioxide embolism. Premedication was with oral diazepam 10 mg. Anesthesia was induced with 0.1 mg fentanyl, 2.5 mg droperidol and 100 mg methohexital (100 mg propofol in one case). Intubation was facilitated with 2 mg pancuronium and 50-100mg succinylcholine. Anesthesia was maintained with nitrous oxide 66% and halothane. Ventilation was controlled with a tidal volume of 10 ml per kilogram body weight at a rate of 10 per minute. Monitoring included ECG, automated non-invasive blood pressure, capnometry, pulse oximetry and body temperature. Anesthesia was uneventful prior to insufflation. In each case the signs and symptoms began approximately 5-8 minutes after the start of insufflation and consisted of an initial tachycardia rapidly followed by ventricular dysrhythmias, bradycardia and cardiac arrest. The end-tidal CO2 decreased during the tachycardic phase and prior to asystole. The patients were cyanotic with engorged jugular veins. Resuscitation with closed chest heart massage and intravenous epinephrine or orciprenaline was successful in every case. The typical "mill wheel phenomenon" of gas embolism was audible on auscultation after heart activity had returned, but disappeared after about 5 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

The ethics of neonatal resuscitation at the margins of viability: informed consent and outcomes.

OBJECTIVES: To determine the adequacy of records of parental counseling in mothers with threatened preterm delivery before 27 weeks gestation, whether interventions performed at birth were consistent with recorded antenatal decisions and whether extent of resuscitation affected the occurrence of serious short-term morbidity. STUDY DESIGN: Antenatal consultation records and records of resuscitation and short-term outcomes were analyzed of 65 mothers with threatened delivery at 21 weeks to 26 weeks and 6 days gestation, and their 61 infants who delivered before 27 weeks. RESULTS: Discussions about survival rates and the frequency of handicap were more likely to be recorded before 25 weeks gestation than after; the adequacy of the records varied among individuals. A decision not to resuscitate was present in 6 of the 13 consultations performed before 23 weeks gestation, and in none of the 52 at 23 weeks or above. A decision to resuscitate only if the infant's condition at birth was good was found in 7 consultations, 6 of which were at less than 24 weeks gestation. All infants born at 23 weeks and above were resuscitated, including the infants with conditional resuscitation decisions. Three of the 6 infants receiving heart massage were discharged alive without major short-term morbidity (severe intracranial hemorrhage, periventricular leukomalacia, or threshold retinopathy). All 8 infants of less than 25 weeks gestation with a heart rate at 3 minutes that was still less than 100 beats/min, in spite of active resuscitation, either died or had major short-term morbidity. CONCLUSIONS: Records of antenatal consultations were often lacking important information. Variations in physician documentation practices are substantial and affect the care offered to infants at the threshold of viability. Even extensive resuscitation can be followed by intact survival if the resuscitation required is brief.

Adult↗