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• W2003245783 abstract "with Open Chest Massage Arthur B Sanders, MD, Karl Kern, MD, Gordon A Ewy, MD, Matthew Atlas, Lynn Bailey Section of Emergency Medicine, Department of Surgery, and Section of Cardiology, Department of Internal Medicine, University of Arizona Health Sciences Center, Tucson There are no studies assessing the effect of open chest massage on survival from cardiac arrest. It has been shown that dogs cannot be resuscitated from prolonged ventr icular fibrillation (VF) and cardiopulmonary resuscitat ion (CPR) if their coronary perfusion pressure (CPP) cannot be ma in ta ined above 30 m m Hg. Accordingly, the canine model was used to determine if thoracotomy and open chest massage could improve survival when the CPP was less than 30 m m Hg after 15 minutes of VF and closed chest CPR. Ten mongrel dogs weighing 20.3 _+ 3.2 kg were anesthet ized wi th pentabarbi ta l (30 mm/kg) and intubated. The right femoral vein was cannulated and a 4 French bipolar pacing catheter was advanced into the right ventricle using ECG guidance. The r ight external jugular vein was cannulated, and a catheter was advanced into the right atrium. The right carotid artery was isolated, and a catheter was advanced into the thoracic aorta. Position of all catheters was confirmed during pos tmor tem examination. The aortic and right atrial catheters were attached to pressure transducers and a mul t i -channel polygraph to cont inuously record aortic and right atrial pressures. Subcutaneous ECG leads were at tached to the dogs' extremities. VT was electrically induced by passing a low-voltage (60-Hz) current through the pacing catheter. CPR was begun immediately Using the mechanical resuscitator set at a compression rate of 60/rain wi th a compression:vent i la t ion ratio of 5:1 and a 50% duty cycle. A compression force sufficient to compress the s ternum 2 inches was used. Ventilation was assisted through the endotracheal tube and the resuscitator using 100% oxygen and a vent i la t ion pressure of 18 cm. Closed chest CPR was continued for 15 minutes. During this time, the dogs were given epinephrine boluses in increasing doses from 0.5 mg to 3 mg every 2 minutes in at tempts to mainta in the CPP laortic minus right atrial diastolic pressure) above 30 m m Hg. At 15 minutes of VF, the coronary perfusion pressure was determined. If the CPP was greater than 30 m m Hg, the dog was excluded from the study; if the CPP was less than 30 m m Hg, the dog was entered into the study and alternatively assigned to the open chest massage (OCM) group or closed chest massage (CCM) group. At 15 minutes, dogs in the OCM group underwent thoracotomy and internal cardiac massage for 3 minutes. At 19 minutes of VF, the dogs were defibrillated wi th 10 joules. The dogs entered in the CCM group continued to receive ex te rna l CPR u n t i l 19 m i n u t e s of VF, w h e n they were defibrillated with 80 joules. At tempts at resuscitation continued for 5 minutes using subsequent doses of epinephrine, lidocaine, and atropine, and cardiac massage, as needed. The dogs were then observed for a total of 20 minutes post defibrillation. The animals were considered resuscitated if they demonstrated a normal sinus rhy thm and main ta ined an aortic pressure on their own at 20 minutes post resuscitation. After this determinat ion was made, the animals were sacrificed and a necropsy was performed. Four of the five dogs in the OCM group were resuscitated and survived for 20 minutes post defibrillation. None of the 5 dogs in the CCM group was resuscitated. This was a statistically significant difference by the Fisher's exact test (P < .05). Student t test analysis of the hemodynamic data showed significant differences between the OCM and CCM groups in the systolic and diastolic pressures and CPP at 1 and 2 minutes of open chest massage (P < .05). The results of this study indicate that survival can be improved using open chest massage when closed chest massage fails to produce an adequate coronary perfusion pressure. Prolongation of the QT Interval and Malignant Ventricular Dysrhythmia in Acute Myocardial Infarction Dale C Askins, DO, Wayne Seutter, DO Department of Emergency Medicine, Grand Rapids Osteopathic Hospital, Grand Rapids, Michigan A retrospective study of patients wi th acute myocardial infarct ion (AMI) was init iated to evaluate the relationship of a prolonged QT interval and malignant ventr icular dysrhythmia. Recent reports have elevated the significance of a long QT interval and l i fethreatening dysrhythmias. Frequent PVCs, multifocal PVCs, couplets, or R on T phenomenon in the face of AMI demands ant idysrhythmic prophylaxis. In those patients wi th AMI and no PVCs, a prolonged QT interval could define another subset at risk. Util izing the formula of Bazett," @default.
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• W2003245783 date "1983-10-01" @default.
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• W2003245783 title "Improved survival from cardiac arrest with open chest massage" @default.
• W2003245783 doi "https://doi.org/10.1016/s0196-0644(83)80232-7" @default.
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