Minimally invasive direct cardiac massage versus closed-chest cardiopulmonary resuscitation in a porcine model of prolonged ventricular fibrillation cardiac arrest.
Open chest cardiac massage has been shown to be superior to closed-chest cardiopulmonary resuscitation for both hemodynamics produced during resuscitation and ultimate resuscitation success. The inexperience of many rescuers with emergency thoracotomy, along with the associated morbidity contributes to the continued reluctance in the use of invasive cardiopulmonary resuscitation techniques. A device has been developed for performing 'minimally invasive' direct cardiac massage. This technique was compared to standard closed-chest CPR for resuscitation results in 20 swine during prolonged ventricular fibrillation cardiac arrest. Minimally invasive direct cardiac massage was superior to closed-chest CPR for return of spontaneous circulation (7/10 vs. 2/10; P<0.02) and coronary perfusion pressure at 30 min of CPR (17+/-9 vs. 6+/-6 mmHg; P<0.05). No significant injuries altering outcome were found with the invasive device. Throughout most of the time course of the study no significant differences in end-tidal expired carbon dioxide levels were noted. Nor were there any differences in 24-h survival. Improvements in assuring proper placement of the device on the epicardium should make this technique a potent advanced cardiac life support adjunct.
Paiva
E F
EF
Department of Emergency Medicine, University of São Paulo School of Medicine, Rua Cristiano Viana, 765 apt 141, CEP 05411-000 São Paulo, Brazil. ed_paiva@mandic.com.br
Kern
K B
KB
Hilwig
R W
RW
Scalabrini
A
A
Ewy
G A
GA
D000704:Analysis of Variance; D000818:Animals; D002245:Carbon Dioxide / Q000502:physiology; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000706:statistics & numerical data; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006336:Heart Massage / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D006439:Hemodynamics; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D011897:Random Allocation; D018709:Statistics, Nonparametric; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*
D002245:Carbon Dioxide