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PubMed1976

[Possibility of early operations in severe traumatic shock under the protection of assisted circulation].

The results of treatment in 28 patients with extremely severe multiple injuries are analysed: 21 of them had open, comminuted, crushed fractures or tearing of 44 extremities. After a failure of antishock measures an assist extracorporeal circulation with oxygenation was instituted, and surgery was performed. In 128 experiments on dogs a explosive bullet wound was inflicted on the knee joint: a comminuted intraarticular fracture of 2-3 bones was produced, followed by 25-30% bloodletting and additional trauma of the damage site. In 23 control experiments without using the heart-lung machine but with routine antishock measures 83% of animals died after the amputation and 17%--survived. A conclusion is made on the rationale and efficacy of an assist extracorporeal circulation in severe traumatic shock, that would make is possible to perform an early operation and to eliminate "the trigger mechanism" of shock.

Adult↗
PubMed1975

[Evaluation of 2 years' experience with assisted circulation by diastolic counterpulsation].

The authors report their two years' experience of circulatory assistance by diastolic counter-pulsation with an intra-aortic balloon. This technique was used in 23 patients: 9 cases of cardiogenic shock due to acute myocardial infarction, 9 septal ruptures, 1 rupture of the papillary muscle of the mitral valve, 1 acute ventricular aneurysm, 2 high risk coronary arteriographies and 1 case of early post-infarction recurrent ischemia. It confirms the gravity of cardiogenic shock as, in spite of the frequent improvement in hemodynamic parameters under counter-pulsation, there was only one survivor. The efficacy is greater in cases of septal rupture, where the author obtained 3 survivors out of 6 operated cases. The security of the method and its innocuity permit one to carry out high risk coronary arteriography and extend the indications for circulatory assistance, to certain cases of unstable angina or early recurrent anginal following acute infarction.

Adult↗
PubMed1980

[Towards a non-invasive left-ventricular assisted circulation. Experimental study].

An original system of closed chest direct left ventricular circulatory assistance was assessed in the dog. The system comprises a compact centrifugal pump, a left ventricular cannula for aspiration and an arterial cannula for reinjection of the blood. The cannulae may be introduced by retrograde arterial catheterisation, the first by retrograde transaortic catheterisation and the second positioned in the descending thoracic aorta. This circuit was evaluated in a dog model of acute myocardial infarction involving 39+/-8 p. 100 of left ventricular mass. Mechanical circulatory assistance maintained an extracorporeal output (78+/-5 ml/min/kg) identical to the cardiac output measured immediately beforehand. Left ventricular emptying was complete (LVEDP = -2.3+/-2.5 torr), its external work becoming nil. The pulmonary artery pressure (13.1+/-0.8 torr) and pulmonary artery resistances (311+/-28 dynes/cm.s-5) were significantly lower, whilst no increase in systemic resistance was observed (3 134+/-300 dynes/cm.s-5). During the new haemodynamic equilibrium St segment elevation at the centre and at the edge of the cyanosed myocardium was significantly reduced to (p < 0.05). Irreduceable ventricular fibrillation at coronary artery ligature occurred in two animals. Spontaneous reversion to sinus rhythm was observed when circulatory assistance was started. Termination of left ventricular circulatory assistance after 2 hours was accompanied by a significant (p < 0.005) fall in cardiac index (59+/-7 ml/min/kg), increase in left ventricular filling pressure (LVEDP 7.8+/-1.8 torr), increase in systemic resistance (3 803+/-404 dynes/cm.s-5). The electrical changes of myocardial ischemia worsened (p < 0.005). No valvular or parietal complications of cannulization were observed. This protocol shows the practical value of the original left ventricular circulatory assistance circuit described. The results suggest that a significant reduction of myocardial ischemia due to coronary artery ligature may be achieved by this means. a clinical trial of the value of this extra corporeal circulatory assistance in the treatment of cardiogenic shock is suggested.

Animals↗