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At least 1,153 records · Page 64Linked to original sources
PubMed1976

The esophageal obturator airway. A clinical evaluation.

The esophageal obturator airway (EOA) has been considered a useful ventilatory technique for cardiopulmonary resuscitation, but quantitative analysis of its clinical effectiveness is not available. We evaluated the EOA in 18 patients who had suffered prehospital cardiac arrest and who were resuscitated by mobile intensive care unit paramedics employing an EOA. Arterial blood gas determinations were obtained during ventilation with the EOA and then repeated after endotracheal intubation. Arterial oxygen tension (PaO2) greater than 64 mm Hg was achieved in 11 of 12 patients who had been converted to supraventricular rhythm, despite varying inspired oxygen concentrations. A PaO2 greater than 77 mm Hg was achieved in three of six patients still requiring external cardiac massage. There was little or no improvement in oxygenation after endotracheal intubation, implying that the failures to oxygenate were not due to the EOA. We conclude that the EOA is a useful adjunct during cardiopulmonary resuscitation when endotracheal intubation is not feasible.

Adult↗
PubMed1993

[Efficacy of external cardiac massage in a patient in the prone position].

This paper reports a case of successful CPR performed in a female patient in the prone position during the excision of a cerebellar meningioma. It was realised by means of an external, posterior thoracic compression below the left shoulder-blade, without any anterior compression as described in two previous reports.

Cerebellar Neoplasms↗
PubMed1971

Attitudes and long-term adjustment of patients surviving cardiac arrest.

Twenty patients surviving cardiac resuscitation following myocardial infarction were seen at least six months after the cardiac arrest. The patient and spouse were interviewed separately. Though they had not usually been informed by the medical staff, 16 of the 20 patients were aware that a cardiac arrest had occurred and had a good understanding of what this meant. Six patients remembered the start or end of the cardiac arrest and five specifically remembered external cardiac massage. Their feelings and their attitudes to the cardiac arrest are described.Initial anxiety was experienced by all the patients and their spouses, particularly after hospital discharge, but in the long term only five patients failed to make a reasonably satisfactory adjustment. Poor rehabilitation seemed to be mainly associated with persisting physical disability and personality factors and not with features associated with the cardiac arrest, such as the duration of external cardiac massage. The spouses often found it difficult to know exactly how to treat the patients after hospital discharge and most patients and spouses felt that more explanation and discussion with the medical staff would have helped to alleviate anxiety.

Adult↗
PubMed1982

Sitting or prone? Another argument for the latter.

The case is described of a one-year-old child who underwent a craniectomy in the prone position for the removal of an ependymoma of the cerebellar vermis which had invaded the fourth ventricle. Circulatory arrest occurred. External cardiac massage was successfully carried out without any change of position, and the operation was satisfactorily completed. It is suggested that such an outcome would have been less likely had the patient been in the sitting position. The value of capnography as a guide to the adequacy of the circulation is emphasized and illustrated.

Blood Circulation↗
PubMed1981

Experimental design for study of cardiopulmonary resuscitation in dogs.

Many different designs for studies of various aspects of cardiopulmonary resuscitation (CPR) in dogs are described in the literature. No single technique is generally accepted. We present a systematized approach to the study of CPR in the canine model. Cardiac output, arterial blood pressure, and electrocardiogram were recorded for three different methods. The methods studied were closed chest compression, closed chest compression with an automatic gas-powered chest compressor, and open chest manual cardiac massage. Cardiac output for both types of external chest compression were less than 17% of control in all cases. With open chest cardiac massage, systemic arterial blood pressures were in the 50 mm Hg to 100 mm Hg range and cardiac output of up to 70% of control was achieved. Using a metronome to obtain compression rate and the arterial blood pressure to guide the efficacy of compression, consistent levels of cardiac output could be achieved for up to 30 minutes using open chest cardiac massage. Closed chest massage in man results in a cardiac output of 25% to 30% of normal when performed under optimal conditions. A cardiac output of 25% to 30% of control cannot be achieved in large dogs with external chest compression, and hence is not a good model to stimulate CPR in man.

Animals↗
PubMedDate not supplied

Alternative cardiopulmonary resuscitation devices.

Cardiopulmonary resuscitation (CPR) involving manual external chest compression combined with artificial respiration was first described in 1960 by Kouwenhoven et al. (Kouwenhoven W, Jude JR, Knickerbocker GG. Closed-chest cardiac massage. JAMA. 1960; 173:1064-7). In the four decades since then, there have been no widely accepted alternatives for this technique. Even with the subsequent worldwide adoption of CPR and other advanced cardiac life support measures, long-term survival after prehospital cardiac arrest is still typically only 5%, to 10%. The performance of CPR must therefore be improved to increase the rate of long-term survival. Currently under development are new, alternative techniques such as interposed abdominal compression (IAC), active compression-decompression (ACD), pneumatic and nonpneumatic circumferential chest compression, and minimally invasive cardiac massage. Many of these newer techniques, compared with standard manual CPR, appear to provide superior vital organ blood flow and increased blood pressure. To date, only IAC (in-hospital only) and ACD have been shown to improve long-term survival in clinical studies. Circumferential chest compression and minimally invasive cardiac massage, on the other hand, have not yet been adequately tested in large clinical trials. Despite the difficulty and expense in studying these CPR techniques, additional research is necessary to evaluate their effectiveness in improving survival after sudden cardiac arrest.

Advanced Cardiac Life Support↗
PubMed1985

A study of the techniques of cardiac massage with the abdomen open.

The present study compares the hemodynamic effectiveness of closed-chest cardiac massage (CCCM) with closed subdiaphragmatic massage (CSDM) and four open transdiaphragmatic cardiac massage techniques during cardiac arrest with an open abdomen. In 10 dogs CCCM resulted in the lowest cardiac index (CI), mean arterial pressure (MBP), and carotid blood flow (CBF) of all cardiac massage techniques tested. CSDM was not statistically superior to CCCM in the dog (p greater than 0.05) but did result in a 23% increase in CI and a 54% increase in CBF. Transdiaphragmatic retrocardiac massage through an incision in the diaphragm resulted in the highest CI, MBP, and CBF of all the four open transdiaphragmatic techniques and had significantly higher values than those for CCCM in the dog (p less than 0.05). In three cadaveric renal donors, all four open transdiaphragmatic techniques and CSDM were noted to be equal to or superior to CCCM. Three patients have been successfully resuscitated with diaphragmatic cardiac massage techniques for cardiac arrest while undergoing abdominal operations. These studies reveal that all subdiaphragmatic or transdiaphragmatic techniques for cardiac massage are hemodynamically equivalent to or superior to the standard CCCM without such complications as fractured ribs and should be considered the treatment of choice for cardiac arrest in the patient with an open abdomen.

Abdomen↗
PubMed2005

Open-chest cardiopulmonary resuscitation: past, present and future.

Out-of-hospital cardiac arrests account for approximately 1000 sudden cardiac deaths per day in the United States. Since its introduction in 1960 closed-chest cardiac massage (CCCM) often takes place as an attempt at resuscitation, although its survival rates are low. Other resuscitation techniques are available to physicians such as open-chest cardiopulmonary resuscitation (OCCPR). OCCPR has been shown by several scientists to be hemodynamically superior to CCCM as it increases arterial pressures, cardiac output, coronary perfusion pressures, return of spontaneous circulation and cerebral blood flow. Improved neurological and cardiovascular outcome and an increase in survival rate compared to CCCM have been described. Timing is one of the key variables in determining patient outcome when performing OCCPR. The American Heart Association in association with the International Liaison Committee (ILCOR) has specific indications for the use of OCCPR. Some investigators recommend starting OCCPR in out-of-hospital cardiac arrests on arrival at the scene instead of CCCM. Surprisingly, the incidence of infectious complications after thoracotomy in an unprepared chest is low. The vast majority of the patients' families accept OCCPR as a therapeutic choice for cardiac arrests and it has been showed to be economically viable. This paper reviews some of the basic and advanced concepts of this evolving technique.

Acidosis↗
PubMed1960

Cardiac arrest--successful resuscitation in the hospital outside the operating rooms.

It is believed that if physicians generally can bring themselves to carry out the drastic action necessary, the benefits of cardiac massage for patients with reflex inhibition of heartbeat can be extended to most cases of this kind occurring anywhere in a hospital, even though there is not time to summon a surgeon or anesthesiologist. This concept requires that attending physicians be prepared to recognize and treat cardiac arrest in salvageable patients. To carry out massage of the heart, a short incision must be made beneath the left breast to permit grasping the heart and starting it again. Mouth-to-mouth breathing until a mask and oxygen arrive is a necessary part of the procedure. Whether to attempt massage must be a decision entirely up to the physician on his appraisal of the circumstances; but the procedure is probably not advisable outside a hospital.

Cardiopulmonary Resuscitation↗
PubMed1978

[Pulmonary bone-marrow embolism. Analysis of 53 cases].

The medical record and the lung sections were reviewed in 53 autoptic cases with pulmonary bone marrow embolism. In 31 cases the emboli could be ascribed to external cardiac massage, in one case to accident; in the other cases a definite aetiologic factor was lacking. The number of the emboli was largely variable from one section to another and sometimes very high (up to 16). The pulmonary bone marrow embolism has probably a clinical significance particularly when the underlying condition is severe.

Adult↗
PubMed1984

Bradycardia and cardiac asystole following a single injection of suxamethonium.

Twenty cases of severe bradycardia, including 12 cases of cardiac asystole, following administration of a single dose of suxamethonium to 17 adult patients are presented. Treatment consisted of i.v. atropine in 16 cases, and in four cases external cardiac massage or a precordial thump was also given. Remission was complete in all cases. The mechanism is not known, but it is suggested that i.v. administration of fentanyl at induction may enhance the tendency to bradycardia following suxamethonium. Absence of preoperative atropine may also be of importance.

Adolescent↗
PubMed1976

[Glycoside induced intestinal ischemia. Therapeutic possibilities (author's transl)].

Intestinal infarction in the absence of organic vascular occlusion received increasing attention in recent years. There is strong evidence from experimental work and clinical observations that cardiac glycosides may play an important role in the pathophysiology of this disorder. Our experiments using the so called mechanical ventricular massage confirm this theory. We could demonstrate that the decrease in mesenteric arterial perfusion following the i.v. administration of ouabain is caused by extracardiac effects of the glycoside on vascular smooth muscle. The Ca++ -antagonistic compound (Verapamil) blocks and reverses the Ca++-synergistic action of the glycoside independent of the time of injection.

Animals↗
PubMed1987

Open-chest cardiac massage after closed-chest compression in a canine model: when to intervene.

Open-chest cardiac massage appears beneficial in improving hemodynamics during resuscitation efforts and in improving resuscitation success. The time between cardiac arrest and the initiation of open-chest cardiac massage is crucial. It would appear that if initiation of open chest cardiac massage is delayed for more than 20 min from the onset of cardiac arrest, little or no successful outcome can be expected. Further techniques for assessing the adequacy of closed-chest compression CPR are needed. Such techniques would allow early identification of ineffective resuscitation efforts and provide the opportunity for early change to other, presumably more effective, techniques.

Animals↗
PubMed1990

[Management of cardiorespiratory arrest in children].

Cardiac arrest in infants and children is usually not unexpected. All efforts, therefore, should be made to recognize a high risk situation soon enough and to apply the emergency therapeutic measures that are mandatory. When the drama occurs, cardiopulmonary resuscitation (CPR) must be instituted at once according to a well-defined sequence: first, elementary CPR performed by any occasional rescuer, including 1. clearing of the airways, 2. mouth-to-mouth breathing, and 3. closed cardiac massage (CCM); then, medical CPR applied by a professional rescuer pursuing the same objectives and consisting of 1. tracheal intubation, 2. manual or mechanical ventilation with pure oxygen, 3. controlled efficacy CCM, and 4. intratracheal, then intravenous or intraosseous injection of adrenaline. As this sequence cannot be improvised, no effort should be spared to teach and organize CPR outside and within hospitals.

Bicarbonates↗
PubMedDate not supplied

[Internal cardiac massage in dogs: a new technique proposition for emergency pericardiotomy--ligament traction].

PURPOSE: Describe a technique of emergency pericardiotomy, named as Ligament Traction (LT), to reduce the necessary time to begin the Internal Cardiac Massage. To perform the ICM an emergency toracotomy and pericardiotomy are necessary, both in remote time. The technique usually employed is the "T" pericardiotomy, whose execution depends on the apprehension of the pericardium with an Allis forceps. This apprehension is difficult and complicates the reanimation of the patient. METHODS: Twenty canine corpses were divided into two groups: Group I--"T" pericardiotomy (n=10), and Group II--the LT technique (n=10). The LT consisted on the traction of the pericardiumphrenic ligament and the section of the pericardium next to its apex. The incision was elongated with the introduction of the fingers, also allowing the positioning of the heart in the hand of the operator and the immediate beginning of the ICM. RESULTS: Group I presented an execution period of 21.79 +/- 0.88 second, and Group II of 8.58 +/- 1.38, with p<0.0001 (highly expressive). CONCLUSION: The technique of pericardiotomy by Ligament Traction concur to outliving, because it avoids a larger time of cerebral ischemia, due to the early beginning of the circulation.

Animals↗
PubMed1982

Open chest resuscitation for cardiopulmonary arrest related to mechanical impairment of circulation: a report of two cases.

Cardiac arrest is most commonly encountered as the end result of severe derangements in metabolic homeostasis. These derangements may include toxic, ischemic, or electrophysiological causes of circulatory and/or respiratory arrests. Occasionally, mechanical obstruction or impediment to circulation may cause cardiac arrest, and forms of resuscitation other than closed chest massage may be required to remove or relieve obstruction. Two cases of cardiac arrest due to mechanical impairment of blood flow are presented. Both occurred during thoracic invasive procedures, and in both cases, the usual externally applied closed chest resuscitative measures were not, and could not have been effective. Emergency thoracotomy promptly restored functional hemodynamics, and allowed the potential for definitive therapy.

Aged↗
PubMed2002

Alternative cardiopulmonary resuscitation devices.

Cardiac arrest survival rates remain low despite increased access to advanced cardiac life support. Survival from cardiac arrest is, at least in part, related to the perfusion pressures and blood flow achieved during cardiopulmonary resuscitation (CPR). A number of alternative CPR devices have been developed that aim to improve the perfusion pressures and/or blood flow achieved during CPR. Active compression-decompression CPR devices are by far the most studied alternative CPR devices, but the results have been inconsistent and conflicting. A number of other devices, including the inspiratory impedance threshold valve, minimally invasive direct cardiac massage, phased chest and abdominal compression-decompression CPR, and vest CPR, are all capable of improving perfusion pressures and/or blood flow compared with standard external chest compressions. However, no convincing human outcome data has been produced yet for any of these devices. Although an interesting area of research, none of the alternative CPR devices convincingly improve long-term patient outcomes.

Animals↗
PubMed1992

[Right coronary spasm immediately after coronary artery bypass grafting for the left coronary artery].

Right coronary spasm immediately after coronary artery bypass grafting for the left coronary artery in a 39-year-old male is described. After the patient was returned to ICU, ECG at leads II, III, and aVF changed suddenly, ventricular tachycardia (right ventricle origin) and cardiac arrest ensured. As neither administration of drug nor application of D.C. was effective. The chest was reopened at ICU. Though there was sufficient flow in the left coronary artery bypass graft flow, the right ventricle did not constrict at all. Right coronary artery spasm was diagnosed, and, upon application of the direct cardiac massage and D.C. at the cardiac surface, cardiac rhythm and blood pressure were normalized. IABP was inserted to improve cardiac function, and the chest was closed. In addition, nitroglycerin and diltiazem were infused continuously. No spasm has occurred after this episode, and the patient has been discharged and is doing well.

Adult↗