Document Detail


Extracorporeal circulation as an alternative to open-chest cardiac compression for cardiac resuscitation.
MedLine Citation:
PMID:  1446500     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Open-chest direct cardiac compression represents a more potent but highly invasive option for cardiac resuscitation when conventional techniques of closed-chest cardiac resuscitation fail after prolonged cardiac arrest. We postulated that venoarterial extracorporeal circulation might be a more effective intervention with less trauma. In the setting of human cardiac resuscitation, however, controlled studies would be limited by strategic constraints. Accordingly, the effectiveness of open-chest cardiac compression was compared with that of extracorporeal circulation after a 15-min interval of untreated ventricular fibrillation in a porcine model of cardiac arrest. Sixteen domestic pigs were randomized to resuscitation by either peripheral venoarterial extracorporeal circulation or open-chest direct cardiac compression. During resuscitation, epinephrine was continuously infused into the right atrium, and defibrillation was attempted by transthoracic countershock at 2-min intervals. Systemic blood flows averaged 198 ml.kg-1.min-1 with extracorporeal circulation. This contrasted with direct cardiac compression, in which flows averaged only 40 ml.kg-1.min-1. Coronary perfusion pressure, the major determinant of resuscitability on the basis of earlier studies, was correspondingly lower (94 vs 29 mm Hg). Extracorporeal circulation, in conjunction with transthoracic DC countershock and epinephrine, successfully reestablished spontaneous circulation in each of eight animals after 15 min of untreated ventricular fibrillation. This contrasted with the outcome after open-chest cardiac compression, in which spontaneous circulation was reestablished in only four of eight animals (p = .038). We conclude that extracorporeal circulation is a more effective alternative to direct cardiac compression for cardiac resuscitation after protracted cardiac arrest.
Authors:
R J Gazmuri; M H Weil; K Terwilliger; D M Shah; C Duggal; W Tang
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Chest     Volume:  102     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1992 Dec 
Date Detail:
Created Date:  1992-12-29     Completed Date:  1992-12-29     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1846-52     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, University of Health Sciences, Chicago Medical School, Illinois.
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MeSH Terms
Descriptor/Qualifier:
Acidosis / therapy
Animals
Blood Pressure / physiology
Carbon Dioxide / analysis,  blood
Cardiac Output / physiology
Coronary Circulation / physiology
Electric Countershock
Extracorporeal Circulation*
Heart Arrest / surgery*,  therapy*
Heart Massage*
Myocardium / metabolism
Oxygen Consumption / physiology
Pulmonary Gas Exchange / physiology
Resuscitation*
Swine
Thoracotomy
Tidal Volume
Time Factors
Ventricular Fibrillation / therapy,  ultrasonography
Grant Support
ID/Acronym/Agency:
1-RO1-HL39148/HL/NHLBI NIH HHS; 1-RO1-HL42590/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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