Zeitschrift für die gesamte innere Medizin und ihre Grenzgebiete
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New results in the area of mechanical cardiopulmonary resuscitation indicate that during external cardiac massage, the blood flow is achieved both by direct cardiac compression and a generalized increase in the intrathoracic pressure. While, in accordance with the classical theory, the heart is compressed between the sternum and the vertebral column, the thoracic pump mechanism requires a consideration of all blood-carrying structures within the thorax as elastic tubes or chambers that are capable of being compressed by externally administered pressure. Only such variations of the technique presently used may be of benefit which can be achieved with simple adjuncts and which have a positive effect on both mechanisms of blood flow.
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The present paper illustrates the physiological basis of brain function as well as the pathophysiological and neurochemical cascades during cerebral ischemia and subsequent reperfusion. It is emphasized that brain resuscitation preferably focuses upon those cerebral functions or structures, respectively, which are not definitely damaged until the early period of recirculation. Finally, current experimental considerations and already clinically established concepts in treatment of ischemic brain injury are pointed out. Their principles of action and their therapeutical value in cerebral resuscitation following cardiocirculatory arrest are discussed.