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At least 1,117 records · Page 62Linked to original sources
PubMed1992

Internal cardiac massage and mediastinal irrigation in hypothermic cardiac arrest.

Two unconscious patients with unknown past medical histories were found to be severely hypothermic, with core temperatures of 80.2 degrees F and 86.7 degrees F, respectively. During the course of active internal rewarming, both patients sustained a cardiac arrest. Emergency thoracotomies were immediately done, and internal cardiac massage with warmed mediastinal irrigation was performed. Spontaneous cardiac activity developed in both patients. Within 24 hours after resuscitation, both patients were responsive and following commands.

Heart Arrest↗
PubMed1989

Conjunctival oxygen monitoring during cardiopulmonary resuscitation.

The conjunctival oxygen tension (CjO2) sensor is a non-invasive, continuous index of oxygen delivery in the haemodynamically unstable patient. Human and animal studies have indicated that CjO2 reflects cerebral blood flow and oxygenation. Simple insertion, rapid stabilization and reaction time less than 60 s allow use in the initial stages of cardiopulmonary resuscitation (CPR) where invasive monitoring is often impracticable. CjO2 was monitored to assess cerebral oxygenation during CPR of 15 patients in cardiac arrest in the accident and emergency department (A&E). Patients who arrested out of hospital with delay to advanced cardiac life support and died had CjO2 less than 20 mmHg (normal CjO2 50-60 mmHg) on arrival in A&E. CPR with closed chest cardiac massage (closed CPR) produced no improvement in CjO2. Patients who arrested in ventricular fibrillation (VF) in A&E, and survived with no neurological deficit had CjO2 greater than 20 mmHg during CPR. However, further episodes of VF produced an immediate fall in CjO2 which continued, despite closed CPR, until restoration of spontaneous cardiac output (RSCO) determined by a palpable carotid pulse. In survivors with delay from arrest to CPR the rise in CjO2 with RSCO did not occur for up to 10 min. This study suggests that closed CPR has no value in maintaining or improving cerebral oxygenation during cardiac arrest. Further studies are required to determine the precise relationship of CjO2 to cerebral blood flow and oxygenation during CPR using open and closed techniques of cardiac massage. Open chest cardiac massage (open CPR) has been shown to produce near normal cerebral perfusion and if patients are to survive prolonged resuscitation neurologically intact guidelines for open CPR must be reviewed.

Aged↗
PubMed1981

[Rupture of the liver secondary to external cardiac massage in a patient with coronary disease : recovery after partial hepatectomy and aortocoronary by-pass (author's transl)].

A 55-year-old man developed ventricular fibrillation during an attack of acute Prinzmetal-type angina, and was treated by external cardiac massage and a defibrillator. Hemorrhagic shock due to laceration of the left side of the liver developed 48 hours later. A liver lobectomy was performed. The postoperative course was uneventful enabling a coronarography examination to be followed by an aortocoronary by-pass, good results being still present after one year. Complications of cardiac massage, especially those involving the liver, are discussed, as well as the treatment of traumatic liver lesions.

Coronary Artery Bypass↗
PubMed1998

[Hepatic lesions after effective external cardiac massage--an iatrogenic complication not to be overlooked].

After external cardiac massage, 3-8% of patients present potentially dangerous liver lacerations. Here we discuss the case of a patient who presented a major haemodynamic instability following external cardiac massage and thrombolytic therapy. Falsely attributed to a cardiac complication, this was actually consecutive to a hepatic haemorrhage originating from liver lacerations caused by the cardiac massage. Haemodynamic stability was obtained by reestablishing blood volume and coagulation factors. Following this the patient evolved favorably. We discuss the importance of evoking the possible existence of abdominal lacerations after external cardiac massage and the therapeutic attitude which must be adopted towards these, particularly in the light of thrombolytic therapy used in interventional cardiology and its effect on these complications.

Contusions↗
PubMed1975

Right atrial laceration. Complication of external cardiac massage.

Right atrial laceration is described as a complication of external cardiac massage in two patients. In each there was a pre-existent cause of weakness of the atrial wall. There was pronounced right atrial dilation with attenuation of the wall in one case, and in the other there was a granulomatous myocarditis involving the atrial wall. The significance of atrial laceration as a complication of traumatic injuries to the heart is discussed.

Aged↗
PubMed1997

Tension pneumopericardium following tracheoplasty for congenital tracheal stenosis.

Tension pneumopericardium is a rare complication of mechanical ventilation following tracheoplasty for congenital tracheal stenosis. This case report describes fatal tension pneumopericardium in a three-month-old male infant some 24 hours following tracheoplasty for this condition. Because of persisting stenosis of the left main bronchus, ventilation pressures of PIP 23 cm H2O and PEEP 5 cm, progressing to PIP 28 cm and PEEP 7 cm were needed to maintain adequate respiratory exchange. Partial relief of the pneumopericardium was achieved by vigorous cardiac massage, but three days later the infant died of massive airway haemorrhage.

Acidosis, Respiratory↗
PubMed1979

Two unexpected deaths from pneumothorax.

Two patients with primary spontaneous pneumothorax died despite intensive treatment. In the first the pneumothorax had been present for 10 days, and, after insertion of a chest drain, pulmonary oedema developed unilaterally, followed by cardiac arrest. She was resuscitated, but later died of a tension pneumothorax on the other side, probably due to cardiac massage and artificial ventilation. In the second patient, after insertion of a chest drain, mediastinal emphysema spread to the head and neck, causing fatal obstruction of the hypopharynx.

Adult↗
PubMed1994

Ventilatory effects of active compression-decompression in dogs.

STUDY OBJECTIVE: To determine the ventilatory effect of active compression-decompression CPR and to compare it with two other techniques, standard manual cardiac massage and mechanical cardiac massage. DESIGN: Prospective, randomized laboratory investigation. PARTICIPANTS: Mongrel dogs. INTERVENTIONS: Nine adult mongrel dogs were anesthetized, intubated, and mechanically ventilated. They were instrumented to measure arterial pressure, esophageal pressure, airway pressure, end-tidal carbon dioxide concentration, and minute ventilation. RESULTS: After induction of ventricular fibrillation, three sequences of cardiac massage were performed randomly during mechanical ventilation, standard cardiac massage, mechanical cardiac massage, and active compression-decompression technique. The animals then were disconnected from the ventilator, and the three sequences were performed again. Active compression-decompression created negative minimum esophageal pressures and significantly decreased the minimum airway pressure as compared with the other techniques. Whatever the ventilatory condition, minute ventilation was increased dramatically during active compression-decompression. CONCLUSION: In this model of cardiac arrest, an important increase in minute ventilation was observed during active compression-decompression. This effect was significantly greater than the increases observed with other techniques of cardiac massage and was related to the negative pressure generated by active decompression.

Airway Resistance↗
PubMed1983

Severe hypotension due to the use of bretylium for postcardiotomy ventricular arrhythmias.

We describe three patients who developed refractory hypotension after the administration of bretylium tosylate for postoperative ventricular ectopy. In one patient, the administration of vasopressors and fluid restored the blood pressure, but in the other two patients these measures failed, necessitating open-heart cardiac massage. The hemodynamic effects of bretylium are unpredictable; therefore, this drug should be used cautiously in the treatment of postcardiotomy ventricular arrhythmias.

Adult↗
PubMed1984

Visceral injuries following external cardiac massage.

This case report describes a patient who sustained a laceration of the hepatic artery during external cardiac massage, a complication which has not previously been reported. The spleen was also damaged. The importance of recognising complications such as haemorrhage from injured abdominal viscera is emphasised and the literature relating to these injuries is briefly reviewed.

Female↗
PubMed1995

Early proponents of cardiac massage.

Open-chest cardiac massage in humans to treat chloroform syncope was first performed by Niehans in Berne and Langenbuch in Berlin in the late 1880s. Closed-chest cardiac massage in humans was advocated by Koenig and Maass in Göttingen in the last two decades of the 19th century. The closed technique was used in Central Europe for several decades to treat chloroform syncope.

Anesthesiology↗
PubMed1987

Long-term survival with open-chest cardiac massage after ineffective closed-chest compression in a canine preparation.

The ultimate goal of cardiopulmonary resuscitation (CPR) is long-term, neurologically intact survival. This study examined whether open-chest cardiac massage could improve 7 day survival and neurologic function when instituted after the failure of standard closed-chest compression CPR. Twenty-nine mongrel dogs were anesthetized and then instrumented with catheters to monitor right atrial and ascending aortic pressures. Ventricular fibrillation was induced and after 3 min standard CPR was begun. Standard CPR was performed with a Thumper programmed for 2 inch chest compressions at 60/min with a 50% duty cycle. External defibrillation was attempted twice after 15 min of ventricular fibrillation. Unsuccessfully defibrillated animals were randomly assigned to either an additional 2 min of continued closed-chest compressions, or 2 min of open-chest cardiac massage. All animals underwent a period of advanced cardiac life support and were followed until they were resuscitated or died. Follow-up care, including scoring of neurologic deficit, was performed for 7 days. In dogs receiving open-chest cardiac massage there was significantly more immediate resuscitation success (14/14 vs 5/14; p less than .005), 24 hr survival (12/14 vs 4/14; p less than .005), and 7 day survival (11/14 vs 4/14; p less than .02) than in those receiving continued closed-chest compression. Open-chest cardiac massage significantly improved long-term outcome when instituted after 15 min of ineffective closed-chest compression.

Animals↗
PubMed2002

Effects of hypertonic saline on myocardial blood flow in a porcine model of prolonged cardiac arrest.

OBJECTIVE: To evaluate the effects of hypertonic saline (HS) on myocardial reperfusion pressure (MPP) and blood flow (MBF), and cardiac index (CI) during and after cardiopulmonary resuscitation (CPR). METHODS: In 21 domestic swine (16-23 kg) open chest cardiac massage was initiated after 10 min of ventricular fibrillation. With the onset of CPR animals randomly received HS (7.2%; 2 ml/kg per 10 min or 4 ml/kg per 20 min) or normal saline ((NS); 2 ml/kg per 10 min). Haemodynamic variables were monitored continuously, and coloured microspheres were used to measure MBF and CI before cardiac arrest (CA), during CPR and 5, 30 and 120 min after the return of spontaneous circulation. RESULTS: During CPR HS significantly increased MPP, MBF, and CI in comparison to NS (P<0.05, resp., MANOVA). Doubling the volume of HS did not improve the haemodynamic effects seen after application of 2 ml/kg per 10 min. HS-infusion significantly increased the survival rate at 120 min, 6/7 and 5/7 animals receiving 2 ml/kg per 10 min or 4 ml/kg per 20 min versus 2/7 after NS-infusion (P<0.05, chi(2)-test). CONCLUSIONS: HS applied during open chest cardiac massage enhanced MBF and CI, and significantly increased resuscitation success and survival rate. The positive effects of this promising new approach need to be confirmed in clinical studies.

Animals↗
PubMed1992

Prolonged resuscitation in acute deep hypothermia.

A case report is described with successful outcome of prolonged cardiopulmonary resuscitation in a 30-year-old man suffering from acute deep hypothermia. His lowest temperature recorded was 23 degrees C. Continuous external cardiac massage was required for a total of 4.5 h whilst rewarming was instituted. The patient eventually left hospital with no permanent sequelae. A review of hypothermia follows, emphasising some important management principals and pitfalls.

Acute Disease↗
PubMed1997

Open-chest cardiac massage without major thoracotomy: metabolic indicators of coronary and cerebral perfusion.

OBJECTIVE: To compare the coronary and cerebral perfusion achieved using a novel method of minimally-invasive, direct cardiac massage to that obtained using bimanual, open-chest cardiac massage. DESIGN: Prospective, controlled animal study with repeated measures. SETTING: University research laboratory. SUBJECTS: Large domestic swine. INTERVENTIONS: Aortic, coronary sinus, jugular venous and pulmonary artery catheters were placed. Following an equilibration period, ventricular fibrillation was induced. After 4 min of untreated ventricular fibrillation, animals underwent bimanual, open-chest cardiac massage (N = 6) or minimally-invasive, direct cardiac massage using a novel device for direct cardiac compression (N = 6). Adrenaline was administered at a dose of 1 mg intravenously every 5 min. MEASUREMENTS: Systemic metabolic parameters, (arterial PO2, PCO2 and lactate concentration) and coronary sinus and jugular venous metabolic parameters (pH, PVO2, SVO2, PVCO2 and lactate concentration) were measured and calculated (coronary sinus/jugular-arterial SVO2, coronary sinus/jugular-arterial PCO2 and lactate differences) at baseline and at 10, 20 and 30 min following induction of ventricular fibrillation. Animals were euthanised after 30 min with no attempt at defibrillation. MAIN RESULTS: Oxygen tension and oxygen saturation of coronary sinus blood declined significantly during the experimental period, but no differences were noted between treatment groups. The coronary sinus-arterial oxygen saturation difference increased during the study with no significant differences between groups. Coronary sinus PCO2 and the coronary sinus-arterial PCO2 difference increased significantly in both experimental groups during cardiac massage. No inter-group differences were noted. A similar relationship was noted in coronary sinus lactate values. The coronary sinus-arterial lactate difference displayed a positive balance at all intervals with no differences noted between group values. The oxygen tension and oxygen saturation of jugular venous blood, were reduced from baseline levels with both treatments. The jugular-arterial oxygen saturation difference increased in both groups compared to baseline values. Between group values were significantly different only at the 20 min interval. Both the jugular venous PCO2 and the jugular-arterial PCO2 gradient were elevated at all intervals, but no inter-group differences were noted. Jugular venous lactate concentration rose steadily with time in both groups. No significant increase in the jugular-arterial lactate gradient was noted at any time point. CONCLUSIONS: Minimally-invasive, direct cardiac massage provides coronary and cerebral perfusion similar to that achieved using standard open-chest cardiac massage. This method may provide a more effective substitute for standard, closed-chest cardiac massage in cases of refractory cardiac arrest.

Animals↗
PubMed1989

[Traumatic complications of indirect cardiac massage].

The author analyzed injuries in 238 subjects where before death indirect cardiac massage was applied by skilled health workers. The ribs were fractures in 27.7% and the sternum in 16% of the deceased, injuries of other organs were detected 13 times (5.5%). In women injuries were more frequent and fractures of the sternum markedly more frequent than in men. While in men rib fractures on the left side were more frequent than on the rights side, in women this difference was not observed. Rib fractures were mostly in the medioclavicular line at the level of the 3rd-5th rib. The fractures of the sternum were also most frequently at the level between the 3rd and 5th rib. No fractures of the 10th-12th rib were found. The author observed an age-depunende cy of rib fractures in men and women, while fractures of the sternum were age-dependent only in men. There was no relationship with age as regards injuries of other organs. Only in two deceased subjects the injury which developed during indirect cardiac massage was the immediate cause of death. Once it was rupture of the interval mammary vein with haemorrhage into the mediastinum and haemorrhage into the chest, in the other case rupture of the right ventricle with cardiac tamponade.

Female↗
PubMed1990

[Cardiorespiratory resuscitation: what is the mechanism of cardiac massage?].

The mechanism involved in the generation of cardiac output during cardiopulmonary resuscitation (CPR) are complex and still controversial. This article reviews the concepts of "cardiac pump" and "thoracic pump", which can both be implicated, before presenting the practical implications as well as the possibilities of development of new CPR techniques.

Animals↗