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A new method of external cardiac massage to improve diastolic augmentation and prolong survival time.

Experiments were performed on 50 dogs to determine the reason for unsatisfactory survival rates following closed-chest cardiac massage and to help develop new means for increasing survival following acute myocardial infarction and other causes of cardiac arrest. A new technique, named the countermassage method, was subsequently developed. Coronary and carotid flows after use of countermassage following cardiac arrest were increased 1.4 and 2 times, respectively, in contrast to flows obtained during manual closed-chest cardiac massage. These increases brought flows up to normal levels. We also tried to determine whether survival could be extended by this method to facilitate clinical treatment such as defibrillation or placing a temporary pacemaker catheter under fluoroscopic control, which are hard to accomplish during the brief time permitted by conventional closed-chest cardiac massage.

Animals↗

[Secondary rupture of the spleen after external cardiac massage].

A case of delayed splenic rupture occurring 18 days after external cardiac massage is reported. A 30 year old woman underwent mitral valve replacement. Two cardiac arrests in the immediate postoperative period were successfully treated by external cardiac massage. Recovery was uneventful until the 18th day, when the patient began to suffer from dizziness. Haemodynamic and biological data suggested hypovolaemia by dehydration. The day after, her abdomen became painful and anaemia was discovered. Splenic rupture was diagnosed by abdominal ultrasonography and splenectomy was carried out; no other lesion was found. In spite of the widespread practice of external cardiac massage, splenic rupture without any other lesion is unusual. It is suggested that abdominal ultrasonography should follow all cardiac massages.

Adult↗

Open cardiac resuscitation. A surgeon's viewpoint.

Open cardiac massage yields better hemodynamic results in the laboratory than does closed cardiac massage. However, reported survival rates with the two methods are similar, except in postcardiotomy patients and patients with penetrating injury. Implementation of resuscitation within several minutes of cardiac arrest is far more important than the specific method used. Closed cardiac massage can be instituted more universally and more quickly than open massage and thus should remain the mainstay of cardiac resuscitation. Open cardiac massage can be performed by trained surgical personnel in appropriate situations.

Animals↗

Evidence for differential sympathetic and parasympathetic reinnervation after heart transplantation in humans.

During heart transplantation (HTX) all neural connections are severed. In humans, signs of autonomic reinnervation have been found. In this study non-invasive tests were used to compare signs of sympathetic and parasympathetic reinnervation. Non-invasive autonomic function tests and heart rate variability parameters (HRV; 24 h electrocardiographic registration) were used to investigate signs of reinnervation. 16 HTX patients (14 males) were compared with age-and sex-matched controls. Parasympathetic heart rate changes in HTX compared to controls were attenuated during the diving test, deep breathing, the Valsalva maneuver and standing up but not during carotid sinus massage. Sympathetic heart rate increases were lower during the cold pressor test and mental stress. The blood pressure responses were comparable to the control group, but not during active standing and tilting. This finding suggests an obligatory 'blood pressure' role for the innervated heart in these two tests. All HRV parameters were lower in HTX. One or more normal parasympathetic responses were found in 13 out of 16 patients versus 4 out of 16 with normal sympathetic responses (p < 0.05). Heart rate variations were less in case of a higher donor age, and higher in case of a longer time after HTX. Parasympathetic signs of reinnervation are more common than sympathetic signs of reinnervation. A higher donor age reduces signs of reinnervation. If the sympatho-vagal balance is a prognostic factor in HTX patients as it is in other cardiac diseases these findings are clinically relevant.

Adult↗

[New aspects of mechanical cardiopulmonary resuscitation].

New results in the area of mechanical cardiopulmonary resuscitation indicate that during external cardiac massage, the blood flow is achieved both by direct cardiac compression and a generalized increase in the intrathoracic pressure. While, in accordance with the classical theory, the heart is compressed between the sternum and the vertebral column, the thoracic pump mechanism requires a consideration of all blood-carrying structures within the thorax as elastic tubes or chambers that are capable of being compressed by externally administered pressure. Only such variations of the technique presently used may be of benefit which can be achieved with simple adjuncts and which have a positive effect on both mechanisms of blood flow.

Animals↗

Direct mechanical ventricular assistance during ventricular fibrillation.

A technique of direct mechanical ventricular assistance (DMVA) has been available since 1966. Ventricular assistance is provided by a glass cup lined with a Silastic diaphragm. It is held on the cardiac ventricles by suction. Alternating positive and negative pressure in the space between the cup and the diaphragm provides a pumping mechanism for blood flow. DMVA was compared to closed chest massage (CCM) and open chest massage (OCM) during ventricular fibrillation in six dogs. Each technique was applied for 10 minutes. Three dogs had CCM followed by OCM and then DMVA. Three dogs had only OCM and DMVA. Blood pressure and cardiac output were measured. All variables were calculated as a percentage of pre-ventricular-fibrillation values. Mean blood pressure was 19.7% with CCM, 39.8% with OCM, and 55.1% with DMVA. Systolic blood pressure was 25.8% with CCM, 51.9% with OCM, and 64.0% with DMVA. Diastolic blood pressure was 17.3% with CCM, 37.3% with OCM, and 48.9% with DMVA. Cardiac output was 13.8% with CCM, 37.1% with OCM, and 58.0% with DMVA. For each variable, OCM produced statistically higher values than did CCM. DMVA produced statistically higher values than did OCM for all variables. These preliminary results suggest that DMVA may be superior to currently available methods of cardiac massage during ventricular fibrillation.

Animals↗

[Cardiac massage: the evolution of techniques].

Up to the 19th century, reanimation of persons apparently dead just included respiratory managing. Cardiac reanimation was born with the accession to anesthesia and their severe cardiac complications. Although closed-chest cardiac massage had been described from the outset of our century, bloody techniques of direct cardiac massage was especially used until the end of the fifties. Methodically, Kouvenhoven has demonstrated closed-chest cardiac massage effectiveness, and has known to lay down this technique in cardiac reanimation.

Cardiology↗