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At least 1,099 records · Page 61Linked to original sources
PubMed1985

Prolonged cardiac arrest and resuscitation in dogs: brain mitochondrial function with different artificial perfusion methods.

Clinical techniques for artificial perfusion have not previously been examined directly for their effects on brain high-energy metabolism. Our study involved 24 large mongrel dogs that were anesthetized, instrumented for central venous intravenous access, and subjected to craniotomy to expose the dura and underlying parietal cortex. The animals were divided into the following six experimental groups of four animals each: nonischemic controls; 15-minute cardiac arrest without resuscitation; 45-minute cardiac arrest without resuscitation; 15-minute cardiac arrest plus 30 minutes resuscitation with conventional cardiopulmonary resuscitation (CPR); 15-minute cardiac arrest plus 30 minutes resuscitation with interposed abdominal compression (IAC) CPR; and 15-minute cardiac arrest plus 30 minutes resuscitation with internal cardiac massage. Cardiac arrest was induced by central venous injection of KCl 0.6 mEq/kg, and it was confirmed by continuous ECG monitoring. The three active resuscitation models included administration of NaHCO3 and epinephrine, but no attempt was made to restart the heart by defibrillation during resuscitation. At the indicated time in each group, a 4- to 5-g sample of brain was removed through the craniotomy, immediately cooled to 0 C and processed for isolation of mitochondria. The mitochondria were studied for their content of superoxide dismutase and for quantitative oxygen consumption with glutamate/malate substrate during resting and ADP-stimulated respiration. Our results show a significant drop in brain mitochondrial superoxide dismutase activity during the first 15 minutes of cardiac arrest. There is minimal injury to brain mitochondrial oxygen consumption during both 15 and 45 minutes of complete ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1981

Contrasts between intrathoracic pressures during external chest compression and cardiac massage.

Pressures were measured in the right atrium, thoracic aorta, and pleural space during conventional cardiopulmonary resuscitation (CPR) and simultaneous ventilation compression cardiopulmonary resuscitation (SVC-CPR) in dogs, pigs, and a baboon. During both forms of closed chest resuscitation, the changes in atrial and aortic pressures were virtually identical over a range of 0-90 mm Hg and essentially equaled the change in pleural pressure measured at the most lateral portion of the chest cavity. During internal cardiac massage, there was no consistent relationship between right atrial and aortic pressures. However, even after the chest had been opened, the hemodynamics of external chest compression could be restored by the creation of a closed, air filled cavity surrounding the heart and great vessels. Thus, elevation of intrathoracic pressure, not direct cardiac compression, is essential to and determine circulation of blood during CPR.

Animals↗
PubMed1996

[Fulminant air embolism in arthroscopy of the shoulder joint using CO2].

We report on a case of an unexpected gas embolism during an arthroscopy of a newly injured shoulder joint. We used carbon dioxide as an arthroscopic medium which has not been considered hazardous up to now. The sudden decrease of the endtidal CO2 concentration in connection with a decrease of peripheral oxygen saturation as well as the clinical symptoms led to an immediate diagnosis of gas embolism. In this case external cardiac massage and aspiration of gas from the right ventricle proved an effective treatment.

Arthroscopy↗
PubMed1988

Physiologic determinants of coronary blood flow during external cardiac massage.

Adequate coronary blood flow is a major determinant for successful resuscitation from cardiopulmonary arrest. To develop compression techniques that optimize coronary blood flow, we implanted in eight dogs electromagnetic flow probes that measured circumflex coronary blood flow and ascending aortic blood flow. Micromanometers measured left ventricular and aortic pressures. Each dog was anesthetized and intubated, and the heart was fibrillated electrically. High-impulse manual chest compressions were performed with the dog in the supine position, and compression rate was varied from 60/min to 150/min. Antegrade coronary blood flow occurred primarily during artificial diastole, and there was a brief period of retrograde coronary blood flow with compression during artificial systole. Cardiac output and diastolic aortic pressure increased with compression rate, significantly augmenting peak coronary blood flow velocity. However, diastolic perfusion time decreased linearly with compression rate and limited coronary perfusion at rates greater than 120/min. As a result, net coronary blood flow during high-impulse manual chest compression was determined primarily by diastolic aortic pressure and diastolic perfusion time. Coronary blood flow was optimized in this model at a compression rate of 120/min.

Animals↗
PubMed2005

Unnecessary interruptions of cardiac massage during simulated cardiac arrests.

BACKGROUND AND OBJECTIVE: Cardiopulmonary resuscitation should not be interrupted until the return of spontaneous circulation or the decision to withhold further treatment. There are no data on how consistent in-hospital cardiopulmonary resuscitation is performed. Accordingly, the aim of the present study was to identify length and type of unnecessary interruptions in simulated cardiac arrests. METHODS: The study was carried out in a patient simulator. A scenario of cardiac arrest due to ventricular fibrillation was used. Resuscitation teams consisted of three nurses, a resident and a staff physician. Using videotapes recorded during simulations, the activities of the teams were coded in 5-s intervals. Unnecessary interruptions were defined as any interruptions in cardiac massage of 10 s or more that were not caused by defibrillation or endotracheal intubation. RESULTS: Twelve teams were studied. The total time of possible cardiac massage was 414 +/- 125 s. In each team at least one unnecessary interruption occurred (range 1-5). Interruptions mounted up to 65 +/- 40 s (range 20-155) or 16 +/- 10% (range 5-41) of the total time of possible cardiac massage. Failure to swiftly resume cardiac massage after an unsuccessful defibrillation accounted for 14 of 39 episodes and for 44 +/- 40% of the time of unnecessary interruptions. The debriefings revealed that participants had generally not noticed the unnecessary interruptions during the simulation. CONCLUSIONS: The present study identified a significant amount of unnecessary interruptions in cardiac massage. These interruptions were not noticed by the health-care workers involved.

Heart Arrest↗
PubMed1975

Persistence of MB isoenzyme of creatine phosphokinase in the serum after minor iatrogenic cardiac trauma. Absence of postmortem evidence of myocardial infarction.

The specificity of serum CPK-MB for acute myocardial infarction was examined by retrospective analysis of 401 consecutive patients admitted to Coronary Care Unit over a three and one-half year period with suspected infarction in whom the isoenzyme was subsequently detected. Four patients (1 per cent) who died during the hospital admission had no autopsy evidence of acute myocardial infarction. All four had experienced mild iatrogenic cardiac trauma, following which serum CPK-MG persisted for at least 24 hours. In one patient, a permanent pacemaker had been inserted by the transmediastinal approach. Two patients had been subjected to closed chest cardiac massage and intracardiac puncture, and one to external cardiac massage alone. The findings suggest that persistent identification of serum CPK-MB, although specific for myocardial necrosis, cannot be regarded as diagnostic of myocardial infarction. The implications of this are important to treatment of patients after cardiopulmonary resuscitation and operative trauma to the heart.

Aged↗
PubMed1992

Widespread myocardial and pulmonary bone marrow embolism following cardiac massage.

Widespread fatal massive bone marrow embolism of the coronary and the pulmonary arteries are described in a 71-year-old man with a respiratory disease. Cardiac massage was carried out during the cardiac arrest. In autopsy findings there were no fractures of the ribs or the sternum. The authors suggested that the cardiac massage was the most important predisposing factor for the bone marrow embolism.

Aged↗
PubMed1995

A technique revisited: hemodynamic comparison of closed- and open-chest cardiac massage during human cardiopulmonary resuscitation.

OBJECTIVE: To compare the hemodynamics of closed-chest cardiac massage vs. open-chest cardiac massage in patients resuscitated from cardiac arrest that occurred outside of the hospital. DESIGN: Prospective, non-outcome, case series. SETTING: Large urban emergency department. PATIENTS: Ten adult, normothermic, nontraumatic, out-of-hospital, cardiac arrest patients who failed advanced cardiac life support (ACLS) therapy. INTERVENTIONS: Patients presenting to the hospital in cardiac arrest were managed according to the ACLS protocol at the clinician's discretion. Proximal aortic and central venous pressure catheters were placed to measure arteriovenous compression- and relaxation-phase pressure gradients. After 5 mins of baseline measurements during closed-chest cardiac massage, patients underwent a left lateral thoracotomy, and open-chest cardiac massage was performed for 5 mins. MEASUREMENTS AND MAIN RESULTS: The mean coronary perfusion pressure and compression-phase pressure gradients were 7.3 +/- 5.7 and 6.2 +/- 5.4 mm Hg, respectively, during closed-chest cardiac massage, while increasing to 32.6 +/- 17.8 and 32.6 +/- 29.9 mm Hg, respectively, during open-chest cardiac massage. The differences between both measurements were statistically significant (p < .05). CONCLUSIONS: Open-chest cardiac massage is superior to closed-chest cardiac massage in providing relaxation-phase and compression-phase pressure gradients during cardiac arrest in patients failing current ACLS protocols. During open-chest cardiac massage, all patients exceeded the minimum coronary perfusion pressure of 15 mm Hg, which is recommended to obtain a return of spontaneous circulation. Further outcome studies are needed to determine the timeliness and appropriate indications for open-chest cardiac massage.

Aged↗
PubMed2000

[Manual chest compressor for cardiac massage for patients transported on a litter--Part 2: Return to the air balloon method and the future direction of the study].

The prior idea of sternal compression with an inflatable balloon inserted between the chest wall and the precordial metal plate was not realized due to the compressibility of gases. Based on the thoracic pump theory of cardiac massage, an accordion type balloon with a wider contact area to the chest wall was made after many years' of unsuccessful trials of various energy transmission methods. Since the compression power to the chest with this device does not exert extra weight underneath the patient, it can be used on a patient being transported on a litter. It is a simple, safe and light weight device and can be used on a helicopter as well, because the balloon can be inflated from an adjacent seat in the helicopter. Applying the principle of lever, it demands less muscle work compared with the conventional method of cardiac massage. Therefore, it may be useful even in hospitals. For the push-pull method of cardiac massage, however, an electric device may be promising when a.c. electricity or a light weight battery is available.

Air↗
PubMed2005

Open indirect cardiac massage in neonate.

Open, direct cardiac massage (OCM), as a technique of resuscitation has not been very inspiring due to its various limitations. We report a case of resuscitation where open 'indirect' cardiac massage was used to resuscitate a neonate successfully. A 24 hr old neonate with multiple gastrointestinal anomalies presented for emergency laparotomy. Intraoperatively she suffered a cardiac arrest. External chest compressions (ECC) failed to produce detectable circulation and surgeons were asked to initiate direct cardiac compressions. They could palpate and successfully compress the heart without the need to split the diaphragm. This 'infra-diaphragmatic' approach resulted in adequate circulation and subsequent uncomplicated recovery.

Abdomen↗
PubMed1979

Impact of cardiopulmonary resuscitation training on resuscitation.

Restoration of adequate spontaneous circulation after "arrest" and cardiopulmonary resuscitation (CPR) of 546 patients before and 460 patients after initiation of a CPR training course in a 500-bed city hospital is reported. Between January 1972 and June 1976, adequate circulation after CPR was present in 38.6% of patients before and 50.4% after training ICU nurses and house physicians in modern resuscitation techniques. Factors crucial to resumption of adequate circulation are: (1) CPR training of all hospital personnel so that effective CPR can be started immediately after recognition of an arrest situation, (2) production of a palpable pulse with closed chest cardiac massage, and (3) prompt effective therapy so that the time interval between arrest and resumption of adequate spontaneous circulation is short.

Blood Circulation↗
PubMed2002

[A portable sternal compressor for cardiac massage on a patient carried by a litter--Part 3: Applicability of the device tested by a recording manikin].

Effects of a portable sternal compressor developed by us was examined by 43 medical students (28 males and 15 females) and 9 anesthesia residents using a recording manikin. Compression over a depth of 3.5 to 5.0 cm was classified as adequate. First, the examinee held the device affixed in front of the chest with a belt hanged over the shoulder and pulled the other handle back and forth at a rate of 100 per minute. The male students could perform adequate compression in 92% of the total number of compression in the first one minute, while female students could in 65%. Though the anesthesia residents accomplished 99% of success rate in the first one minute, the rate fell to nearly 80% in the next minute and about 50% thereafter due to fatigue. When one handle was sustained on the floor with its fold-in stand and held between the knees of the examinee sitting on a chair, adequate compression was performed with the success rate of over 80% for 5 minutes. We conclude this device will be useful for cardiac massage on a patient either transported on a litter or lying on a soft bed.

Adult↗
PubMed1997

Cardiac arrest during dobutamine stress echocardiography.

In this report, we describe the case of a woman with normal coronary arteries who experienced a cardiac arrest during a dobutamine stress test. The patient was successfully treated with external cardiac massage. The possible mechanisms underlying this unusual life-threatening side effect of dobutamine infusion are discussed.

Adrenergic beta-Agonists↗
PubMedDate not supplied

Successful treatment of severe hypothermia and prolonged cardiac arrest with closed thoracic cavity lavage.

This case report describes the resuscitation of a 19-year-old man who had been immersed in ice water for 14 h and presented with a rectal temperature of 22 degrees C and no pulses. It reports the successful use of prolonged cardiac massage (3.5 h) and closed thoracic cavity lavage in the treatment of severe hypothermia. It also confirms that victims of severe hypothermia can be effectively treated in peripheral hospitals not equipped for cardiopulmonary bypass.

Adult↗