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[Physiological aspects of cardiopulmonary resuscitation in adults].

This article reviews the physiology of cardiopulmonary resuscitation (CPR), monitoring and new devices for generating blood flow during CPR. Two controversial mechanisms of blood flow during chest compressions are described: the thoracic pump mechanism and cardiac pump mechanism. Also, new physiological aspects of blood flow, physiology of ventilation and gas transport during CPR are overviewed. A variety of alternative techniques and devices are now explored in order to improve perfusion pressures and/or blood flow during CPR, including active compression decompression CPR, inspiratory impedance threshold valve, phased chest and abdominal compression-decompression CPR and others. Initial methods of cardiopulmonary resuscitation monitoring are direct observations of pulse and respiration. Electrocardiogram remains the most essential tool for diagnosis and monitoring of cardiac arrest. Monitoring of diastolic blood pressure, myocardial perfusion pressure and end-tidal CO2 are also useful. Other types of monitoring during cardiac arrests can provide information about effectiveness of CPR.

Adult↗

[Successful resuscitation of intractable hyperkalemic cardiac arrest].

We report on a 42-year-old oliguric uremic man on regular hemodialysis who developed sudden cardiac arrest, secondary to severe hyperkalemia, with a plasma potassium concentration of 9.7 mEq x l(-1). The cardiac arrest persisted after the initiation of cardiopulmonary resuscitation and intensive treatment for marked hyperkalemia for an hour and 55 minutes. Therefore a portable percutaneous cardiopulmonary support (PCPS) system had to be instituted while the patient had very prolonged refractory ventricular fibrillation. His cardiac rhythm was restored immediately after application of PCPS and he recovered without neurological sequelae. We therefore suggest that PCPS should be considered as a therapeutic option during cardiopulmonary resuscitation for life-threatening cardiac arrest secondary to severe hyperkalemia.

Adult↗