title: Open-chest CPR improves survival and neurologic outcome following cardiac arrest.
abstract: OBJECTIVE
  To determine if 15 min of open-chest cardiac massage (OC-CPR) versus closed-chest compressions (CC-CPR) improves 72-h survival and neurologic outcome (behavioral and histologic) after 5 min of untreated cardiac arrest.
  
  
  METHODS
  Mongrel dogs were anesthetized and instrumented. Cardiac arrest was induced by KCl injection and after a 5-min period of non-intervention, dogs were randomized to receive either CC-CPR (N = 7) or OC-CPR (N = 5) performed for 15 min. The dogs were then resuscitated and physiologic data was recorded. Surviving dogs were scored at 72 h using canine neurodeficit score of Safar et al. (NDS; 0 = behaviorally normal, 500 = brain death). Dogs that could not be resuscitated or died before 72 h were assigned a score of 500. Brain histology was performed on all survivors.
  
  
  RESULTS
  All OC-CPR dogs were successfully resuscitated and were behaviorally normal at 72 h (NDS = 0). Histology in OC-CPR dogs showed little to no injury. Only three out of the seven CC-CPR dogs survived to 72 h. Of the survivors, one dog exhibited minor ataxia (NDS = 15), and two had incapacitating deficits (both NDS = 180). Two dogs died within 24 h after extubation, and one could not be resuscitated and the other could not be weaned from the ventilator (each NDS = 500). Histology of the CC-CPR survivors revealed moderate to severe lesions. NDS between groups was statistically significant (p < 0.0079).
  
  
  CONCLUSIONS
  In our canine model of cardiac arrest, OC-CPR significantly improved 72-h survival and neurologic outcome when compared to CC-CPR.
authors.affiliation: Department of Emergency Medicine, St. John Hospital and Medical Center, 22101 Moross Road, Detroit, MI 48236, USA.
authors.forename: Don M
authors.initials: DM
authors.lastname: Benson
authors.forename: Brian
authors.initials: B
authors.lastname: O'Neil
authors.forename: Edward
authors.initials: E
authors.lastname: Kakish
authors.forename: John
authors.initials: J
authors.lastname: Erpelding
authors.forename: Sarah
authors.initials: S
authors.lastname: Alousi
authors.forename: Reginald
authors.initials: R
authors.lastname: Mason
authors.forename: David
authors.initials: D
authors.lastname: Piper
authors.forename: Jose
authors.initials: J
authors.lastname: Rafols
mesh_terms: D000818:Animals; D001831:Body Temperature; D001921:Brain / Q000473:pathology; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004195:Disease Models, Animal; D004285:Dogs; D006323:Heart Arrest / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D006336:Heart Massage / Q000379:methods*; D006439:Hemodynamics; D009422:Nervous System Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D020127:Recovery of Function; D016019:Survival Analysis; D016896:Treatment Outcome