Summary
Need for cardiac resuscitation occurs in approximately 1:1,000 to 1:2,000 surgical procedures. Early recognition by the anaesthetist is important. The surgeon may be required to assist in the diagnosis.
The final diagnosis is best made by observing the heart through a left thoracotomy. The thoracotomy incision should be large, in the fourth left interspace and avoiding the internal mammary artery.
The most common cause is myocardial anoxia with or without reflex activity, anaesthetic agents, or cardiac manipulation.
Early instigation of treatment is important. Respiratory resuscitation should be carried on at the same time as cardiac resuscitation. Cardiac massage is best maintained using two hands and should be started within 4 min. Myocardial tone may be improved using calcium chloride or adrenalin. Ventricular fibrillation is treated by electrical shock, 170–220 v., 1.5 amp., and 0.2 sec.
Defibrillation should not be attempted until the myocardium is oxygenated and the fibrillating movements become coarse. Cardiac massage may be necessary after defibrillation. Cardiac defects such as valvular stenosis should be corrected during massage if possible. All treatment should be aimed at reducing the total time of cerebral anoxia. When resuscitation has been completed, careful postoperative care is necessary.
The best method of treatment is prevention.
Résumé
On pratique la resuscitation cardiaque pour traiter ľarrêt cardiaque, soit la fibrillation ventriculaire, soit une activité cardiaque inadéquate. II s’impose de recourir à cette sorte de traitement dans 1:1000 à 1:2000 des interventions chirurgicales. La cause la plus fréquente de cette situation est ľanoxie du myocarde avec ou sans ľaide ľune activité réflexe ďagents anesthésiques ou čune manipulation cardiaque. Le diagnostic, habituellement, est fait par ľanesthésiste qui observe les signes vitaux et, finalement, en pratiquant une thoracotomie gauche. Le traitement peut être fait par un anesthésiste, un chirurgien ou toute autre personne qualifiée et ce traitement consiste à faire un massage cardiaque précoce, à employer du chlorure de calcium ou de ľadrénaline et, s’il y a lieu, un défibrillateur électrique. On pratique un massage plus adéquat en se servant de ses deux mains. La défibrillation par choc électrique s’opère facilement lorsque le myocarde a été oxygéné par le massage et que les mouvements fibrillatoires du ventricule sont passés de petits à plus gros.
Les facteurs les plus Jmportants sont la mise en œuvre précoce du traitement et la capacité de maintenir une circulation adéquate par le massage.
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References
Barber, R.F., &Madden, J.L. Historical Aspects of Cardiac Resuscitation. Am. J. Surg.70: 135 (1945).
Bailey, H. Cardiac Massage for Impending Death under Anaesthesia. Brit. Med. J.2: 84 (1941).
Johnson, J., &Kirby, C.K. Cardiac Standstill and Ventricular Fibrillation. Am. Pract.5: 264 (1954).
Stephenson, H.E., Reid, L.C., &Hinton, J.W. Some Common Denominators in 1200 Cases of Cardiac Arrest. Ann. Surg.137: 731 (1953).
Miller, F.A., Brown, E.B., Buckley, J.J., Van Bergen, F.H.; &Varco, R.L. Respiratory Acidosis. Its Relationship to Cardiac Function and other Physiologic Mechanisms. Surgery32: 171 (1952).
Cooley, D.A. Cardiac Resuscitation during Operations for Pulmonic Stenosis. Ann. Surg.132: 930 (1950).
Wienberger, L.W.;GibBON, M.H., &Gibbon, J.H.,Jr. Arch. Neurol & Psychat.43: 615 (1940).
Thompson, S.A., &Roche, E.F. The Effect of Mechanical Artificial Respiration upon the Maintenance of the Circulation. Surg., Gynec. & Obst.84: 1059 (1947).
Hurwitt, E.S., &Seidenberg, B. Rupture of the Heart during Cardiac Massage. Ann. Surg.137: 115 (1953).
Haight, C., &Sloan, H. Successful Cardiac Resuscitation despite Perforation of the Heart during Massage. Ann. Surg.141: 240 (1955).
Cookson, B.A., Costos-Durieux, J., &Bailey, C. P. The Toxic Effects of Citrated Blood and the Search for a Suitable Substitute for Use in Cardiac Surgery. Ann. Surg.139: 430 (1954).
Melrose, D.G., &Wilson, A.O. Intra Arterial Transfusion: The Potassium Hazard. Lancet1: 1266 (1953).
Jarditzky, O., Greene, E.A., &Forbes, V. Oxygen Consumption of the Completely Isolated Dog Heart in Fibrillation. Circ. Res.4: 144 (1956).
Wiggers, C.J. The Physiologic Basis for Cardiac Resuscitation from Ventricular Fibrillation: Method for Serial Defibrillation. Am. Heart J.20: 413 (1940).
McMillan, I.K.R., Cockett, F.B., &Styles, P. Cardiac Arrest and Ventricular Fibrillation. Thorax7: 205 (1952).
Beattie, E.J., Keshishian, J.M., Ames, N.B., &Blades, B. Ann. Surg.137: 504 (1953).
Milstein, B.B., &Brock, Sir Russell. Ventricular Fibrillation during Cardiac Surgery. Hosp. Rep.103: 213 (1954).
Kountz, W.B. Revival of Human Hearts. Ann. Int. Med.10: 330 (1936).
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Presented at the Western Divisions’ Meeting, Canadian Anaesthetists’ Society, Calgary, Alberta, March 13, 1958.
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Dodds, W.A., Ashmore, P.G. Cardiac resuscitation. Canad. Anaesth. Soc. J. 6, 75–82 (1959). https://doi.org/10.1007/BF03014198
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DOI: https://doi.org/10.1007/BF03014198