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[Direct cardiac massage in refractory heart arrest. 2 cases sucessfully treated in the coronary care unit]
Insights
Direct cardiac massage offers a life-saving alternative when closed chest techniques fail for cardiac arrest. This method successfully revived two patients unresponsive to conventional resuscitation, demonstrating its effectiveness in critical situations.
Area of Science:
- Cardiology
- Emergency Medicine
- Surgical Resuscitation
Background:
- Closed chest cardiac massage is the standard resuscitation technique.
- Certain critical cases, like ventricular fibrillation unresponsive to electrical countershocks, may require alternative methods.
Observation:
- Two patients with ventricular fibrillation, unresponsive to closed chest massage and electrical countershocks, were treated with open chest direct cardiac massage.
- The procedure was performed outside the operating room.
Findings:
- Direct cardiac massage, combined with a single D.C. countershock, successfully restored normal sinus rhythm in both patients.
- Neither patient experienced complications such as intrathoracic infection, cardiac rupture, or postresuscitative bleeding.
- Both patients survived and were discharged from the hospital.
Implications:
- Open chest cardiac massage is a viable and effective resuscitation technique in select cases where closed chest methods fail.
- Performing thoracotomy outside the operating room can be safe and successful.
- This approach can improve survival rates for patients with refractory ventricular fibrillation.
Abstract:
The open chest, or direct cardiac massage may be indicate in instances where closed chest techniques are ineffective. Direct cardiac massage was successfully applied by us in two patients who failed to resuscitate with closed chest massage. The patients, an 49 year old man with acute myocardial infarction and an 53 year old man who had a history of previous myocardial infarction with subsequent development of a ventricular aneurysm, had ventricular fibrillation who not responded to closed chest cardiac massage and to repeated electrical countershocks. When the pupils became dilated the decision was made to open the chest and apply direct massage. After several minutes of manual cardiac compression a single D.C. countershock returned the heart to a normal sinus rhythm in each of the patients. Although the thoracotomy was performed outside the operating room, none of the complications of the open chest resuscitation occurred, such as intrathoracic infection, rupture of the heart, and postresuscitative bleeding. The first patient recovered from the infarction, has been discharged from the hospital and is alive and well after 5 months. The second patient has been discharged from the U.C.C. and is alive and well after 15 days.