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PubMed1995

Successful myocardial revascularization and neurologic recovery in a patient with prolonged refractory cardiac arrest and a chronically occluded left internal carotid artery.

Heretofore, the longest successfully treated cardiac arrest reported in the literature, secondary to myocardial ischemia, was one that required 45 minutes of cardiopulmonary resuscitation before coronary bypass surgery. We present a unique case of successful resuscitation after a cardiac arrest secondary to myocardial ischemia. The arrest lasted 78 minutes (30 minutes of closed cardiac massage and 48 minutes of open cardiac massage). As soon as a perfusionist was available, cardiopulmonary bypass was initiated. After completion of the distal anastomosis and upon removal of the aortic cross clamp, the patient spontaneously recovered sinus rhythm for the 1st time since her cardiac arrest 2 hours and 10 minutes earlier. This 70-year-old woman, with a history of chronic occlusion of the left internal carotid artery, recovered fully, without evidence of neurologic or myocardial insult. We believe that vigorous closed and open cardiac massage, followed by cardiopulmonary bypass and the correction of myocardial ischemia, enabled this patient to survive a prolonged refractory cardiac arrest.

Aged↗
PubMed1988

A physiologic comparison of external cardiac massage techniques.

On the basis of recent investigation, controversy has arisen regarding which of several cardiopulmonary resuscitation methods optimizes hemodynamics. The present study was designed to compare five recently described chest compression techniques: high-impulse manual chest compression at 150/min, mechanical compression at 60/min with simultaneous ventilation, mechanical compression at 60/min with simultaneous ventilation and either systolic or diastolic abdominal compression, and pneumatic vest compression at 60/min. Eight dogs were chronically instrumented with electromagnetic flow probes in the ascending and descending aorta while matched micromanometers measured aortic, left ventricular, and pleural pressures. At study, each dog was anesthetized with morphine, intubated, and the heart was fibrillated by rapid ventricular pacing. The five cardiopulmonary resuscitation methods were performed randomly in each preparation within 7 to 10 minutes of arrest. In four dogs, brachiocephalic blood flow was computed as total cardiac output minus descending aortic blood flow, and in all dogs coronary perfusion pressure was calculated as mean diastolic aortic pressure minus mean diastolic left ventricular pressure. Average cardiac output for seven studies was 662 +/- 61 ml/min with high-impulse manual compression, 340 +/- 46 ml/min with mechanical compression and simultaneous ventilation, 336 +/- 45 ml/min with mechanical compression and simultaneous ventilation with systolic abdominal compression, 366 +/- 52 ml/min with mechanical compression and simultaneous ventilation with diastolic abdominal compression, and 196 +/- 29 ml/min with vest resuscitation (high-impulse manual compression significantly greater than other techniques by multivariate analysis, p less than 0.05). Brachiocephalic blood flow generally followed cardiac output and was statistically the greatest with high-impulse manual compression at 273 +/- 47 ml/min (p less than 0.05). Finally, high-impulse manual compression provided the highest coronary perfusion pressure of 31 +/- 4 mm Hg (p less than 0.05) compared to 23 +/- 2 mm Hg for mechanical compression and simultaneous ventilation, 23 +/- 2 mm Hg for mechanical compression and simultaneous ventilation with systolic abdominal compression, 23 +/- 3 mm Hg for mechanical compression and simultaneous ventilation with diastolic abdominal compression, and 11 +/- 2 mm Hg for vest resuscitation. These data demonstrate that high-impulse manual compression generated physiologically and statistically superior hemodynamics when compared with other methods in this model of cardiopulmonary resuscitation.

Animals↗
PubMed1991

Limitations of open-chest cardiac massage after prolonged, untreated cardiac arrest in dogs.

STUDY OBJECTIVES: Open-chest cardiac massage is an effective method of resuscitation if instituted within 15 minutes of normothermic cardiac arrest that has failed to respond to ongoing closed-chest CPR efforts. The usefulness of invasive forms of CPR after various periods of untreated cardiac arrest is less certain. This study was performed to determine the effectiveness of open-chest resuscitation after prolonged periods of untreated cardiac arrest. SETTING AND DESIGN: Prospective, controlled laboratory investigation using an animal model of cardiac arrest. Open-chest cardiac massage initially was compared to standard closed-chest compression CPR. The efficacy of open-chest CPR then was evaluated after ten and 40 minutes of untreated ventricular fibrillation. TYPE OF PARTICIPANTS: Twenty mongrel dogs (24 +/- 1 kg). MEASUREMENTS AND MAIN RESULTS: After 20 minutes of untreated ventricular fibrillation, open-chest resuscitation was significantly better than closed-chest efforts for the production of coronary perfusion pressure (58 +/- 14 vs 2 +/- 1 mm Hg; P less than .05) and initial resuscitation success (five of five vs one of five; P less than .03). Open-chest cardiac massage was equally effective for initial resuscitation if begun after ten or 20 minutes of untreated ventricular fibrillation (five of five vs five of five), but if untreated ventricular fibrillation continued for 40 minutes prior to instituting open-chest massage, no resuscitation benefit was found (none of five; P less than .005). There were marked differences in 24-hour survival depending on the length of time untreated cardiac arrest continued prior to instituting open-chest resuscitation efforts. After 20 minutes of ventricular fibrillation, initial resuscitation was successful with open-chest massage, but long-term survival was poor. CONCLUSION: Open-chest cardiac massage did not produce long-term survival if untreated cardiac arrest persisted for 20 or more minutes prior to invasive resuscitation efforts.

Animals↗
PubMed1980

The history of cardiopulmonary resuscitation.

The development of modern cardiopulmonary resuscitation (CPR) is an exciting and surprising history to modern health professionals who rarely are aware of how new CPR really is. Artificial respiration began in the 16th century with Vesalius's work on living animals; progressed with the rise and fall of mouth-to-mouth, manual, and positive pressure ventilation methods of the 18th and 19th centuries; and culminated in 1958 with demonstration of the superiority of the mouth-to-mouth technique. Cardiac massage began in 1874, with the open chest method gaining ascendancy until the 1960 demonstration of the equality and greater ease of closed chest cardiac massage. Electrical defibrillation may have begun in 1775, but was not proven successful in animals internally until 1899. The technique was applied to man internally in 1947 and externally in 1956. The simultaneous use of all these modern CPR methods dates back only 20 years.

France↗
PubMed1973

Lightning injury: two case histories and a review of management.

Two cases of fatal lightning injury are described. Fixed dilated pupils should not be taken as an indicator of death after a lightning strike. Persons who fail to breath spontaneously within one minute of lightning shock should receive external cardiac massage and mouth-to-mouth resuscitation. Paralysis may persist as result of cerebral oedema or prolonged hypoxia-it is therefore suggested that adequate ventilation and metabolic balance should be maintained until recovery or death.

Adolescent↗
PubMed1995

[The internal thoracic artery of poor quality: was cardiac massage a cause of ITA stenosis?].

The case of stenotic left internal thoracic artery (LITA), with a very rare and interesting histological findings is reported. The patient, a 65-year-old man, fell into shock, due to acute myocardial infarction and received cardiopulmonary resuscitation at home immediately. Three months later, patient underwent coronary artery bypass grafting. The LITA was dissected from the chest wall with a tissue pedicle by usual manner. However, it was abandoned to use for grafting, because of extremely poor blood flow even after balloon dilatation was noticed. Histological study revealed a significant granulation of LITA media, led to severe stenosis of LITA lumen on it's portion. On other side, either proximal and distal portion of LITA remained intact. It seems that this unusual histological change of LITA media developed after LITA over stretching due to cardiac massage during cardiopulmonary resuscitation. If patient, scheduled for coronary bypass surgery, has in a personal history the presence of cardiac massage, traffic accident, some contact sport or any other chest trauma, it is recommended to perform LITA angiography preoperatively, if an intention to use the LITA for coronary artery bypass grafting exists.

Cardiopulmonary Resuscitation↗
PubMed1975

Distal propulsion of vena cava umbrella by cardiac massage.

Distal propulsion of a 28 mm umbrella filter from vena cava to femoral vein occurred in a 75-year-old woman during external cardiac massage. After cardiac massage, filter position must be checked roentgenographically. Optimal management of distal migration might include placement of a second umbrella to prevent recurrent emboli and proximal migration of the dislodged umbrella.

Aged↗
PubMed1991

Recent advances in cardiopulmonary resuscitation.

Reversal of cardiac arrest is contingent on rapid and effective restoration of myocardial blood flow. Thirty years have elapsed since closed-chest cardiopulmonary resuscitation (CPR) was introduced in clinical practice. Because of its technical simplicity and noninvasiveness, CPR was rapidly implemented and almost universally utilized for cardiac resuscitation. However, there is increasing concern about its value for cardiac resuscitation since the limited hemodynamic efficacy of precordial compression accounts for a disappointingly low success rate. More invasive interventions by which blood flow is restored such as open-chest cardiac massage or extracorporeal circulation are consistently more effective than conventional CPR. Experimentally, both methods restore systemic and myocardial perfusion to viable levels and thereby increase the likelihood of restoring spontaneous circulation even after prolonged cardiac arrest or failure of conventional CPR.

Cardiopulmonary Resuscitation↗
PubMed1983

Cerebral cortical perfusion during and following resuscitation from cardiac arrest in dogs.

Perfusion of the cerebral cortex during closed chest CPR in dogs, generating systolic pressures of 60 to 70 mmHg, is only 10% of pre-arrest blood flow. In contrast, internal cardiac massage produces normal cortical perfusion rates. Following a 20-min perfusion arrest, during pressure controlled reperfusion, cortical flow rates decay to less than 20% normal after 90 min of reperfusion. This appears to be due to increasing cerebral vascular resistance, and is not due to rising intracranial pressure. The post-arrest cortical hypoperfusion syndrome is prolonged with cortical flow remaining below 20% normal up to 18 hr post arrest. The use of a variety of calcium antagonists, including flunarizine, lidoflazine, verapamil, and Mg2+, immediately post-resuscitation maintains cerebral vascular resistance and cortical perfusion at normal levels. A prospective blind trial of the calcium antagonist lidoflazine following a 15-min cardiac arrest in dogs and resuscitation by internal massage, demonstrates amelioration of neurologic deficit in the early postresuscitation period.

Adenosine Triphosphate↗
PubMed1990

Estimation of cerebral blood flow during cardiopulmonary resuscitation in humans.

Cerebral blood flow (CBF) and cardiac output (CO) were measured during cardiopulmonary resuscitation in patients who were unsuccessfully resuscitated by use of C14-iodoantipyrine injected into the left ventricle. CO varied between 1.3 and 2.2 l/min with mean 1.8 +/- 0.6 l/min (+/- SD) (28 ml/kg/min). The cortical CBF was found between 14 and 211 ml 100 g-1.min-1 with mean 42 ml 100 g-1.min-1 and mean white matter CBF equal to 27 ml 100 g-1.min-1. It is suggested that the external cardiac massage in humans may be of poor efficacy in terms of brain revival. Cortical CBF after long-lasting cardiopulmonary resuscitation showed signs of maldistribution suggestive of a patchy and incomplete perfusion.

Aged↗
PubMedDate not supplied

[Atrial fibrillation induced by massage of the carotid sinus in patients with orthodromic reciprocal supraventricular tachycardia and Wolff-Parkinson-White syndrome].

A 46 years old man with WPW syndrome, due to a posteroseptal accessory pathway, was admitted because of orthodromic reciprocating tachycardia, 210/m'in frequency. At the end of the carotid sinus massage, for accomplish the conversion of tachycardia to sinus rhythm, the orthodromic reciprocating supraventricular tachycardia degenerated into atrial fibrillation associated with high ventricular rate and the presence of hemodynamic instability, reverted to sinus rhythm by intravenous propafenone. Vagal stimulation, induced by carotid sinus massage, probably caused dispersion of atrial refractorines and intraatrial reentry, converting the orthodromic tachycardia into atrial fibrillation. The transesophageal electrophysiologic study, executed in treatment with propafenone, not documented the accessory connection and atrial fibrillation or reciprocating tachycardia were not inducible.

Atrial Fibrillation↗
PubMed1996

[Emergency coronary artery bypass grafting under cardiopulmonary resuscitation: a successful case report].

A successful case of emergency coronary artery bypass grafting for a 69-year-old man with refractory cardiac arrest due to impending myocardial infarction was reported. Preoperative full resuscitation including external cardiac massage was required. The duration from cardiac arrest to cardiopulmonary bypass establishment was 24 minutes and aortic cross clamping time was 29 minutes for triple bypass grafting to the right, left circumflex and left anterior descending coronary artery.

Aged↗
PubMed1999

Gas embolism during hysteroscopy.

PURPOSE: Gas embolism during hysteroscopy is rare but sometimes fatal. A fatal case of gas embolism during diagnostic hysteroscopy using carbon dioxide (CO2) is presented. CLINICAL FEATURES: A 68 yr old woman was admitted for treatment of myoma and cancer of the uterus. Hysteroscopy using CO2 was performed without monitoring or anesthesia on the ward. At the end of the examination, just after the hysteroscope was removed, she developed tonic convulsions, lost consciousness, and her pulse was impalpable. Cardiac massage was started, anesthesiologists were called and the trachea was intubated. She was transferred to the intensive care unit with continuous cardiac massage. Cardiac resuscitation was successful. A central venous line was inserted into the right ventricle under echocardiography in an attempt to aspirate gas with the patient in the Trendelenberg position, but the aspiration failed. Positive end expiratory pressure and heparin for emboli, midazolam for brain protection, and catecholamines were administered. Fifteen hours after resuscitation, the pupils were enlarged and she died 25 hr after resuscitation. CONCLUSION: Gas embolism is a rare complication of hysteroscopy. The procedure should be performed with monitoring of blood pressure, heart rate, oxygen saturation and end-tidal CO2 concentration.

Aged↗
PubMed1990

The clinical rationale of cardiac resuscitation.

After failure of external defibrillation, return of cardiac activity with spontaneous circulation is contingent on rapid and effective reversal of myocardial ischemia. Closed-chest cardiopulmonary resuscitation (CPR) evolved about 30 years ago and was almost universally implemented by both professional providers and lay bystanders because of its technical simplicity and noninvasiveness. However, there is growing concern since the limited hemodynamic efficacy of precordial compression accounts for a disappointingly low success rate; especially so if there is a delay of more than 3 minutes before resuscitation is started. There is also increasing concern with the lack of objective hemodynamic measurements currently available for the assessment and quantitation of the effectiveness of resuscitation efforts. Accordingly, the resuscitation procedure proceeds without confirmation that it increases systemic and myocardial blood flows to levels that would be likely to restore spontaneous circulation. Continuous monitoring of end-tidal carbon dioxide (PETCO2) now appears to be a practical measurement which provides a noninvasive quantitative indication of both systemic blood flow and coronary perfusion pressure. Consequently, PETCO2 predicts the likelihood of successful resuscitation and guides the operator who may modify the technique of precordial compression to improve systemic and myocardial perfusion. Among the large polypharmacy for cardiac resuscitation, only alpha-adrenergic agents (which increase coronary perfusion pressure) and especially epinephrine are of proven benefit. Neither buffer agents nor calcium salts appear to improve outcome except under unique conditions. To the contrary, there is increasing awareness of adverse effects of pharmacologic interventions such that they may hinder the return of viable myocardial and cerebral function. This has constrained the routine use of all drugs except for the use of alpha-adrenergic agonists. More invasive interventions by which blood flow is restored such as open-chest cardiac massage or extra-corporeal pump oxygenation (ECPO) are consistently more effective than conventional CPR. Experimentally, both methods promptly restore systemic and myocardial perfusion to viable levels and thereby increase the likelihood that spontaneous circulation is restored even after prolonged cardiac arrest or failure of conventional CPR.

Heart Arrest↗
PubMed1994

Successive cardiac death of brothers in association with stress.

A 38-year-old man (Case 1) suddenly collapsed while resting. His 54-year-old brother (Case 2) came soon thereafter began to perform cardiac massage and mouth-to-mouth resuscitation. However, the elder brother suddenly died after resuscitating his younger brother for about 30 minutes. Necropsy revealed an occlusive thrombus of the left anterior descending coronary artery and coagulation necrosis of the myocardium in Case 1. Case 2 was diagnosed as sudden cardiac death on the basis of the moderate coronary sclerosis and myocardial lesions including contraction band, fragmentation, waviness, bleeding, and mild subendocardial fibrosis. Pulmonary edema in the both cases revealed the presence of left ventricular heart failure. Case 2 is a good example of the contribution of psychological and physical stress to sudden cardiac death.

Adult↗
PubMed1990

The introduction of closed chest cardiac massage.

The introduction of closed chest cardiac massage by Dr William Kouwenhoven and associates has markedly changed the outcome of patients with cardiac arrest. The fortuitous discovery of the simple yet ingenious concept of closed cardiac massage has saved countless lives. In fact the manuscript published by Kouwenhoven and colleagues has been touted "to have resulted in saving more lives than any other medical manuscript during the past century." Although newer techniques and methods of cardiac resuscitation have been developed, their successes will be measured against the technique described by Kouwenhoven and colleagues.

Heart Massage↗
PubMed1989

Hemodynamic effects of external cardiac massage in trauma shock.

The effectiveness of closed chest cardiopulmonary resuscitation (CCCPR) in maintaining cardiac output has been well studied in cardiac arrest. Trauma surgeons most often encounter shock secondary to hypovolemia or cardiac tamponade, and the effectiveness of CCCPR in that setting has not been established. To determine the hemodynamic effects of external massage in profound shock, hypotension was induced in baboons. Pressures obtained with external massage were compared to spontaneous intra-arterial pressures before compression. Although external massage increased systolic pressures in both tamponade and hypovolemia, diastolic pressures were consistently decreased. We conclude that CCCPR does not augment arterial pressure in the clinical situations associated with decreased LVEDV and is unlikely to provide organ perfusion for trauma victims.

Animals↗