Classique open chest massage numbers

[Charles Brault <c.bro@videotron.ca>]

Ann Emerg Med 1984 Sep;13(9 Pt 2):770-3
Manual open-chest cardiopulmonary resuscitation.

Bircher N, Safar P

Although the mechanistic differences between standard external 
cardiopulmonary resuscitation (SCPR) and open-chest CPR (OCCPR) are clear, 
it remains unclear when OCCPR offers a benefit over SCPR for nontraumatic 
cardiac arrest. Experimentally OCCPR has been shown to generate much higher 
arterial and much lower venous pressures, resulting in increased perfusion 
pressures across both heart and brain. Most studies have shown increased 
blood flow with OCCPR. Mechanical OCCPR has been shown to sustain 
electroencephalographic activity for up to one hour after up to four 
minutes of arrest. It has been shown in several studies that cardiac 
resuscitability is greater with OCCPR than with SCPR. Cerebral blood flow 
approaches normal with OCCPR; the best reported for SCPR is 50% of normal. 
After four minutes of cardiac arrest, OCCPR for 30 minutes does not yield a 
neurological deficit significantly different from immediate defibrillation; 
all animals studied returned to nearly normal by 24 hours 
postresuscitation. After the same arrest time, nearly all animals receiving 
either SCPR or simultaneous ventilation-compression CPR for 30 minutes were 
dead by 24 hours. Clinically early series reported up to 28% survivorship 
(patients discharged home) after OCCPR. Survivors after up to 2.5 hours of 
OCCPR and after successful restoration of spontaneous circulation by OCCPR 
after failure of SCPR for 75 minutes have been reported. Reported 
incidences of wound infection and iatrogenic cardiac injury range from 0 to 
9.1% and 0 to 1.4%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

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