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At least 865 records · Page 48Linked to original sources
PubMed1976

Clinical conference: Rupture of right ventricle complicating closed chest cardiac massage.

Two cases of rupture of the right ventricle following closed chest cardiac massage are presented. This is believed to result from trapping of blood in the right ventricle at levels of systemic arterial pressure. In one case there was massive pulmonary embolism which interfered with egress of blood from the right ventricle. In the other case, application of pressure during a closed chest resuscitative attempt might have closed the right ventricular outflow tract.

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PubMed1987

Open versus closed chest cardiac massage in non-traumatic cardiac arrest.

Since the rediscovery and popularization of closed-chest cardiopulmonary resuscitation (CPR) in the early 1960s, this technique has largely replaced open-chest cardiac massage. However, in the ensuing quarter of a century, a large amount of data has been accumulated that seems to indicate that open-chest CPR is the physiologically superior method of cardiopulmonary resuscitation. This paper reviews that data comparing these two CPR modalities. The first part discusses data obtained from animal studies, while the second considers the limited amount of information that has been obtained from human investigations. The authors concludes that a randomized clinical trial of open-chest and closed-chest CPR is needed to fully evaluate the efficacy of these two resuscitative techniques as well as to define the most appropriate circumstances for the use of internal cardiac massage.

Animals↗
PubMed2001

Left ventricular free wall rupture possibly induced by coronary spasm. Surgical repair in the emergency room.

A 68-year-old woman complained of chest discomfort after a traffic accident in which she driving hit a child. At about twenty-five minutes later, she went into sudden cardiogenic shock due to acute myocardial infarction caused by non-occlusive intracoronary thrombosis without significant organic coronary stenosis and without any sign of extraluminal contrast pooling on coronary angiography. She was transported to our emergency room by ambulance because of cardiac tamponade caused by a left ventricular free wall rupture following the acute myocardial infarction. On arrival, she was near cardio-pulmonary arrest on intraaortic balloon pumping. We performed emergency open cardiac massage and pericardiotomy. The hairline perforation responsible for the blowout-type left ventricular free wall rupture was successfully closed with Teflon-reinforced sutures. In conclusion, it was strongly suspected that the present case of left ventricular free wall rupture was caused by acute myocardial infarction due to intracoronary thrombosis following coronary spasm without significant organic coronary stenosis or rupture of atheromatous plaque.

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PubMed1979

An analysis of cerebral bood flow systemic base deficit accumulation and mean arterial pressure as a function of internal cardiac massage rates.

The effect of varying rate of internal cardiac massage on the cerebral blood flow equivalent (CBF/CMRO2 = (Formula: see text), where CBF = cerebral arteriovenous oxygen difference, CMRO2 = Cerebral metabolic oxygen consumption, and (Formula: see text), = cerebral; arteriovenous oxygen content difference) was investigated in the dog. Also, systemic base balance and mean arterial pressure were analyzed as functions of rate. Nine dogs 14-27 kg in weight were subjected to rates of 14-200 compressions per minute. For rates between 14 and 200 per minute, there was no significant rate-related effect on the parameters monitored.

Acid-Base Imbalance↗
PubMed1977

Cardioinhibitory carotid sinus hypersensitivity. Intracardiac recordings and clinical assessment.

Cardioinhibitory carotid sinus hypersensitivity most frequently occurs in elderly men, predominantly during right carotid massage. Resting sinus bradycardia and aortic stenosis may be unusually prevalent in this subgroup of patients. Ventricular arrest occurs abruptly and may be preceded by brief prolongation of sinus cycle lengths and atrioventricular nodal conduction times. Gradual recovery of the sinoatrial rate follows resumption of sinus rhythm and is preceded by atrioventricular nodal recovery. His bundle electrocardiography is valuable in excluding other potential causes of syncope in patients with carotid sinus hypersensitivity. Despite a history of syncope, permanent pacing may not be indicated in the management of patients with carotid sinus hypersensitivity and otherwise normal electrophysiologic study.

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PubMed2005

Back from irreversibility: extracorporeal life support for prolonged cardiac arrest.

BACKGROUND: The survival of patients after prolonged cardiac arrest is still inadequate. Extracorporeal life support (ECLS) represents an alternative therapeutic method for patients who do not respond to conventional cardiopulmonary cerebral resuscitation. This technology is used to support the circulation of a patient with severe cardiac failure. METHODS: Between June 1997 and January 2003, 40 ECLS procedures were performed in patients who presented with refractory cardiac arrest. During external cardiac massage, the patient was connected to an extracorporeal circuit by the insertion of an arterial and venous cannula through the femoral vessels. The extracorporeal circuit included a centrifugal pump and an oxygenator. Mean age was 42 +/- 15 years; the average time of external cardiac massage was 105 +/- 44 minutes. RESULTS: Once the circulation was restored, 22 patients were disconnected from the extracorporeal circulation because of brain death or multiorgan failure; after 24 hours, among the 18 survivors, 6 were weaned off the pump, 9 were bridged to a ventricular assist device, and 2 patients were directly bridged to cardiac transplantation. Eight patients are alive and without any sequelae at 18 month's follow-up. CONCLUSIONS: In prolonged cardiac arrest with failing conventional measures, rescue by extracorporeal support provides an ultimate therapeutic option with a good outcome in survivors. Our results encourage the wider application of ECLS for refractory cardiocirculatory arrest in selected patients. The high rate of neurologic death needs further improvements in the early phase of resuscitation maneuvers.

Adult↗
PubMed2001

Cardiac resuscitation after incremental overdosage with lidocaine, bupivacaine, levobupivacaine, and ropivacaine in anesthetized dogs.

UNLABELLED: There is no information comparing the ability to reverse the cardiotoxic effects associated with incremental overdosage of bupivacaine (BUP) to levobupivacaine (LBUP), ropivacaine (ROP), or lidocaine (LIDO). Open-chest dogs were randomized to receive incremental escalating infusions of BUP, LBUP, ROP, and LIDO to the point of cardiovascular collapse (mean arterial pressure [MAP] < or = 45 mm Hg). Hypotension and arrhythmias were treated with epinephrine, open-chest massage, and advanced cardiac life support protocols, respectively. Outcomes were defined as the following: successful (stable rhythm and MAP > or = 55 mm Hg for 20 min), successful with continued therapy (stable rhythm and MAP <55 mm Hg after 20 min), or death. Continued therapy was required in 86% of LIDO dogs compared with only 10%-30% of the other dogs (P < 0.002). Mortality from BUP, LBUP, ROP, and LIDO was 50%, 30%, 10%, and 0%, respectively. Myocardial depression was primarily responsible for the profound hypotension, as the occurrence of lethal arrhythmias preceding resuscitation was not different among local anesthetics. Epinephrine-induced ventricular fibrillation occurred more frequently in BUP-intoxicated dogs than in dogs given LIDO or ROP (P < 0.05). The unbound plasma concentrations at collapse were larger for ROP, 19.8 microg/mL (10-39 microg/mL), compared with BUP, 5.7 microg/mL (3-11 microg/mL); whereas the concentrations of LBUP, 9.4 microg/mL (5-18 microg/mL) and BUP were not significantly different from each other. IMPLICATIONS: There were consistent differences among the local anesthetics, the sum of which suggests that larger doses and blood concentrations of ropivacaine (ROP) and lidocaine will be tolerated as compared with bupivacaine (BUP) and levobupivacaine (LBUP). Lidocaine intoxication results in myocardial depression from which resuscitation is consistently successful but will require continuing drug support. After BUP, LBUP, or ROP, resuscitation is not always successful, and the administration of epinephrine may lead to severe arrhythmias. The unbound plasma concentrations at collapse were larger for ROP compared with BUP, whereas the concentrations of LBUP and BUP were not significantly different from each other. Furthermore, larger plasma concentrations of ROP than BUP are present after resuscitation, suggesting a wider margin of safety when large volumes and large concentrations are used to establish upper or lower extremity nerve blocks for surgical anesthesia and during long-term infusions for pain management.

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