title: A technique revisited: hemodynamic comparison of closed- and open-chest cardiac massage during human cardiopulmonary resuscitation.
abstract: OBJECTIVE
  To compare the hemodynamics of closed-chest cardiac massage vs. open-chest cardiac massage in patients resuscitated from cardiac arrest that occurred outside of the hospital.
  
  
  METHODS
  Prospective, non-outcome, case series.
  
  
  METHODS
  Large urban emergency department.
  
  
  METHODS
  Ten adult, normothermic, nontraumatic, out-of-hospital, cardiac arrest patients who failed advanced cardiac life support (ACLS) therapy.
  
  
  METHODS
  Patients presenting to the hospital in cardiac arrest were managed according to the ACLS protocol at the clinician's discretion. Proximal aortic and central venous pressure catheters were placed to measure arteriovenous compression- and relaxation-phase pressure gradients. After 5 mins of baseline measurements during closed-chest cardiac massage, patients underwent a left lateral thoracotomy, and open-chest cardiac massage was performed for 5 mins.
  
  
  RESULTS
  The mean coronary perfusion pressure and compression-phase pressure gradients were 7.3 +/- 5.7 and 6.2 +/- 5.4 mm Hg, respectively, during closed-chest cardiac massage, while increasing to 32.6 +/- 17.8 and 32.6 +/- 29.9 mm Hg, respectively, during open-chest cardiac massage. The differences between both measurements were statistically significant (p < .05).
  
  
  CONCLUSIONS
  Open-chest cardiac massage is superior to closed-chest cardiac massage in providing relaxation-phase and compression-phase pressure gradients during cardiac arrest in patients failing current ACLS protocols. During open-chest cardiac massage, all patients exceeded the minimum coronary perfusion pressure of 15 mm Hg, which is recommended to obtain a return of spontaneous circulation. Further outcome studies are needed to determine the timeliness and appropriate indications for open-chest cardiac massage.
authors.affiliation: Department of Emergency Medicine, Henry Ford Health Systems, Detroit, MI 48202.
authors.forename: M E
authors.initials: ME
authors.lastname: Boczar
authors.forename: M A
authors.initials: MA
authors.lastname: Howard
authors.forename: E P
authors.initials: EP
authors.lastname: Rivers
authors.forename: G B
authors.initials: GB
authors.lastname: Martin
authors.forename: H M
authors.initials: HM
authors.lastname: Horst
authors.forename: C
authors.initials: C
authors.lastname: Lewandowski
authors.forename: M C
authors.initials: MC
authors.lastname: Tomlanovich
authors.forename: R M
authors.initials: RM
authors.lastname: Nowak
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002496:Central Venous Pressure; D003326:Coronary Circulation; D004837:Epinephrine / Q000008:administration & dosage; D006323:Heart Arrest / Q000503:physiopathology* / Q000628:therapy*; D006336:Heart Massage / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013908:Thoracotomy
chemical_list: D004837:Epinephrine