Manual open-chest cardiopulmonary resuscitation

Abstract

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)