[Prolonged effectiveness of external cardiac massage in heart arrest].
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A case of deliberate 7-second heart arrest is described. It is assumed that the effect is the result of voluntary self-irritation of peritoneal receptors by means of rhythmical diaphragm muscle contractions realized in conditions of preliminary breathing arrest.
The author reported the successful treatment of a patient with sudden respiratory and heart arrest due to severe closed thoracoabdominal trauma. This experience indicates timely and necessarily frequent thoracic X-ray and blood gas analysis are of paramount importance after closed thoracoabdominal trauma, for which often gives rise to secondary injuries. When the local hospital can not offer essential treatment, severe cases need to be immediately transferred to higher hospital.
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The purpose of the present study was to determine whether myocardial oxygen consumption (MVO2) differs when the heart is arrested by hyperkalemic arresting solution (ASK) or by hypocalcemic arresting solution (ASCa) when coronary flow is maintained constant. MVO2 was measured in 12 isolated, Langendorff-perfused rat hearts alternately perfused with ASK (20 mM K+ and 1.5 mM Ca2+) and ASCa (5 mM K+ and 0.08 mM Ca2+). Six of the hearts were perfused with ASK for 10 min, ASCa for 5 min, ASK for a second 5 min, and finally ASCa for 5 min; ASCa and ASK were opposite in this sequence for the other six hearts. Measurements of MVO2 during ASK and ASCa arrest, taken at the end of each perfusion period, were analyzed to distinguish the independent influences of time and perfusate composition on MVO2 in the arrested hearts (analysis of covariance). Consistent with previous findings, MVO2 decreased with time after the onset of cardiac arrest with both solutions. The average per minute fall was 0.0003 ml O2.min-1.g-1 (P less than 0.01). However, at any given time after arrest, MVO2 averaged 0.004 ml.min-1.g-1 less during ASCa arrest than during ASK arrest (P less than 0.01), which amounted to a 15% reduction in MVO2. To test whether the increased MVO2 during hyperkalemic arrest was dependent on calcium in the perfusion medium, a third series of six hearts was studied in which MVO2 values measured during ASCa and ASK arrest were compared with those measured during arrest by hyperkalemic-hypocalcemic solution (ASK,Ca: 20 mM K+, 0.08 mM Ca2+).(ABSTRACT TRUNCATED AT 250 WORDS)
Atrial electrical activities during hypothermic, K(+)-induced cardioplegic arrest correlate with an increased incidence of postoperative supraventricular dysrhythmias in coronary artery bypass graft patients. Surface electrocardiogram (ECG) (S-ECG) may be insufficiently sensitive to detect such activity intraoperatively, and invasive methods are impractical and traumatic. From induction of anesthesia until the end of surgery, esophageal ECG signals were detected with a new bipolar esophageal probe and a new high-resolution preamplifier (frequency range 0.01-2000 Hz). The S-ECG and the esophageal ECG (E-ECG) were evaluated independently in 18 patients. Eight of 18 patients presented during cardioplegic arrest a mean of 483 +/- 119 high-amplitude, biphasic P components (mean amplitude 0.7 +/- 0.1 mV, range 0.35-1.15 mV) per patient (mean 36 +/- 6 [5-59] potentials/min) similar to those coinciding with the surface ECG P-waves during sinus rhythm. Six of these eight patients presented a mean of 29 +/- 11 low atrial activities (mean amplitude 0.14 +/- 0.023 mV; range 0.1-0.25 mV) per patient (mean 8.4 +/- 5.6 [2.3-48] potentials/min) in the E-ECG. In the S-ECG, one patient of these eight presented 26 P waves during cardioplegic arrest simultaneously with activities in the E-ECG. During the first 5 days, seven of eight (88%) patients with atrial activities in the E-ECG versus 3 of 10 (30%) patients without atrial activities developed supraventricular tachyarrhythmias postoperatively (P < 0.05). This new high-resolution E-ECG device detected in a beat-to-beat technique more atrial activity during cardioplegic arrest than a S-ECG and offered the advantages of artifact exclusion and better prediction of postoperative supraventricular dysrhythmias.
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Morphometric examination of neurons of the Vth layer of the sensorimotor cortex and Purkinje's cells in two functionally different parts of the cerebellum was carried out in various periods after resuscitation in rats exposed to 10 or 15-min heart arrest. General regularities and differences in the reaction of heterogenous neuronal populations on ischemia of various duration were detected. The time course of restructuring of the neuronal populations was traced. A relationship between the detected shifts and the rate of neurological resuscitation of the animals was established. Neurons of various compartments of the brain and various types of cells in the heterogenous neuronal populations were found to be characterized by different sensitivity to ischemia.