Open Heart Massage

Excerpt

Cardiopulmonary resuscitation is one of the most extensively studied and standardized medical procedures. Despite decades of research, guideline updates, and global dedication from professionals, the survival rate for patients experiencing cardiac arrest has not significantly improved, with only about 1 in 10 patients surviving hospital discharge after cardiac arrest. Before the advent of closed-chest compressions in the early 1960s, open cardiac massage (OCM) was commonly used for cardiac arrest.

Typically, OCM is performed in patients with inadequate cardiac output status after emergency thoracotomy for penetrating chest trauma, pericardial tamponade, or after cardiac arrest following chest surgery. Mortiz Schiff, a 19th-century physiologist, first described OCM after heart function cessation in laboratory animals, and in 1880, Niehans performed the first OCM in a human. Kristian Ingelsrud achieved the first successful cardiac arrest outcome with OCM in 1901, and by the 1920s, the technique became widespread. OCM was the preferred method for cardiovascular collapse into the 20th century, notably after Lee and Downs reported an overall survival rate of 25% across 99 cases.

In trauma cases where patients present in cardiac arrest, emergency resuscitative thoracotomy (ERT) is a last-resort measure involving OCM and aortic cross-clamping. OCM aims to establish coronary perfusion pressure, facilitating the return of spontaneous circulation (ROSC), while cross-clamping increases afterload, redirecting limited cardiac output to the brain and heart and isolating any bleeding sources below the diaphragm. Survival rates following ERT with OCM remain low, with only around 15% survival after penetrating trauma and just 1% to 2% after blunt trauma. Neurological outcomes are often poor even when ROSC is achieved; only about 27% of these patients regain consciousness within 28 days, and roughly half of those with ROSC survive hospital discharge. Hypoxic brain injury from delayed ROSC is a leading cause of morbidity and mortality, underscoring the importance of stabilizing cardiopulmonary function and protecting neurological integrity in trauma resuscitation.