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PubMed1978

The capnogram as a guide to the efficacy of cardiac massage.

Recordings from three patients in cardiac arrest are shown to illustrate the importance of monitoring pulmonary perfusion by means of the capnogram as a continuous guide to the cardiac output achieved by cardiac massage and resuscitation. Such monitoring allows the performance to be adjusted to obtain the maximal result.

Carbon Dioxide↗
PubMed1997

Combined epicardial-transthoracic electrode paddle placement: a method for defibrillation during open-chest cardiac resuscitation.

We present a case of open-chest cardiac massage where ventricular fibrillation developed and a direct current shock was required. In the absence of 'surgical' electrode paddles, standard paddle electrodes were used; one small electrode was placed directly on the exposed epicardial surface and the second electrode was placed on the lateral chest wall. Defibrillation was achieved with a 100 J shock. This combined epicardial-transthoracic electrode paddle placement technique allows defibrillation to be accomplished when open chest cardiac massage is being performed and no 'surgical' electrode paddles are available.

Electric Countershock↗
PubMed1987

Open chest cardiac massage: an overview.

Open-chest cardiopulmonary resuscitation has been shown to produce better blood flow in man than closed-chest massage. It therefore should be taught as part of the protocol for all hospital CPR teams.

Cardiac Output↗
PubMed1993

Extracorporeal life support for patients undergoing prolonged external cardiac massage.

From November 1987 to February 1992, extracorporeal life support (ECLS) was used for four patients undergoing prolonged external cardiac massage following cardiac arrest. Their underlying diseases consisted of acute pulmonary embolism, pulmonary arterial thrombosis due to protein C deficiency, acute inferior left ventricular infarction accompanied by right ventricular infarction and thoracic contusion. After the initiation of ECLS, hemodynamic variables and metabolic acidosis improved in all of the cases. The case of pulmonary embolism and the case of acute myocardial infarction were successfully weaned from ECLS without complications. They were later discharged ambulatory from the hospital. The patient with pulmonary arterial thrombosis, who was comatose, became alert after the initiation of ECLS. However the patient finally died due to diffuse and massive pulmonary arterial thrombosis, which was probably related to protein C deficiency. The patient with thoracic contusion was also comatose before ECLS. He did not recover from the coma and died soon after the disconnection of ECLS. The latter two cases were suspected to have had irreversible organ failures not responsive to mechanical support of both circulation and respiration. We conclude that ECLS is a very useful method for patients requiring prolonged cardiac massage following cardiac arrest.

Adult↗
PubMed1984

Improved resuscitation from cardiac arrest with open-chest massage.

A study was done to assess the effect of open-chest massage on resuscitation from cardiac arrest. Ten mongrel dogs weighing 20.3 +/- 3.2 kg were fibrillated electrically. Cardiopulmonary resuscitation (CPR) was initiated and continued for 15 minutes. Half the dogs with coronary perfusion pressures less than 30 mm Hg underwent thoracotomy and internal cardiac massage for three minutes. Closed-chest massage was continued with the other dogs. All dogs were defibrillated at 19 minutes, and resuscitation was determined at 20 minutes after defibrillation. None of the dogs in the closed-chest massage group was resuscitated successfully. Four of the five dogs that underwent open cardiac massage were resuscitated. Significant differences in aortic pressures and coronary perfusion pressures were noted for the first two minutes of open-chest massage (P less than .05). The results of this study indicate that resuscitation may be improved using open-chest massage when closed-chest massage fails to produce an adequate coronary perfusion pressure.

Animals↗