Circulation, Vol 75, 498-503, Copyright © 1987 by American Heart Association
KB Kern, AB Sanders, SF Badylak, W Janas, AB Carter, WA Tacker and GA Ewy
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.
ARTICLES
Long-term survival with open-chest cardiac massage after ineffective closed-chest compression in a canine preparation
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