Circulation
-
Comparative Study
Vest inflation without simultaneous ventilation during cardiac arrest in dogs: improved survival from prolonged cardiopulmonary resuscitation.
Myocardial and cerebral blood flow can be generated during cardiac arrest by techniques that manipulate intrathoracic pressure. Augmentation of intrathoracic pressure by high-pressure ventilation simultaneous with compression of the chest in dogs has been shown to produce higher flows to the heart and brain, but has limited usefulness because of the requirement for endotracheal intubation and complex devices. A system was developed that can produce high intrathoracic pressure without simultaneous ventilation by use of a pneumatically cycled vest placed around the thorax (vest cardiopulmonary resuscitation [CPR]). ⋯ Vest CPR was compared with manual CPR with either conventional (300 newtons) or high (430 newtons) sternal force. After induction of ventricular fibrillation, each technique was performed for 26 min. Defibrillation was then performed.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Management of foreign body airway obstruction continues to be a major controversy in emergency medical care. Much of the disagreement is without doubt based on lack of a uniformly accepted model of acute airway obstruction representative of the clinical event. A variety of models have been used to assess different aspects of airway obstruction by foreign bodies. ⋯ Human volunteers, anesthetized and paralyzed patients, and cadavers have also been used. In several recent studies it was concluded that subdiaphragmatic pressure is the treatment of choice, while in at least one additional study firm back blows applied with the patient's head hanging downward were recommended as the treatment most likely to relieve airway obstruction. It seems likely that these apparently conflicting views can be reconciled and that a consensus recommendation for treatment of this emergency can be effected.
-
Considerable effort has been expended in recent years by a number of laboratories to improve methods of cardiopulmonary resuscitation. This article briefly summarizes 5 years of investigation by our group on hemodynamic support during external cardiac massage. In most studies, long-term canine preparations were used, and implanted transducers allowed precise hemodynamic measurements. ⋯ This method was termed high-impulse CPR. High-impulse techniques now have been applied extensively in the clinical setting, and preliminary observations also support their efficacy in man. Based on this experience, it is suggested that the American Heart Association guidelines be changed to recommend a manual chest compression rate of 120/min during closed-chest cardiac massage.