Cardiac massage in medical patients.
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Histological examination showed acute haemorrhage of the bifurcating His bundle and of the left bundle branch in a 35 year old man who died after being given external cardiac massage for cardiac arrest. "Hammering" of the ventricular septum crest against the central fibrous skeleton of the heart by compression of the sternum was believed to have caused the haematoma of the junctional tissue.
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Theodore Tuffier, in 1898, incised a dying patient's chest on the wards of La Pitie Hospital and carried out manual cardiac massage. This act, based on animal experimentation, led to the first published surgical exposure of the unwounded human heart and illustrates the determination and creativity of a remarkable pioneer.
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The results of cardiopulmonary resuscitation (CPR) have been distressingly poor when one considers the amount of research in this field since 1960. Accordingly, some improvements to present protocols have been suggested. Some of the suggestions can be applied by practicing veterinarians to increase the success rate for external chest massage. In addition, veterinarians are encouraged to switch to internal cardiac massage early in the resuscitation period.
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Of 502 patients handled by a mobile intensive care unit, 70 were resuscitated: 20 immediately, 9 within 3 min and 41 later than 3 min from onset of cardiac or respiratory arrest. There were 9 temporary and 10 longterm survivors among the 29 patients who underwent resuscitative measures within 3 min of collapse. First-aid training programs in resuscitation methods are a necessary supportive measure to the operation of mobile intensive care units.
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