OPEN-CHEST CARDIOPULMONARY-RESUSCITATION IN OUT-OF-HOSPITAL CARDIAC-ARREST

Because closed chest cardiopulmonary resuscitation (CCCPR) achieve res toration of spontaneous circulation (ROSC) in less than 50% of cases, and because of the apparent physiological superiority of open-chest ca rdiopulmonary resuscitation (OCCPR), we evaluated OCCPR in out-of hosp ital cardiac arrest in cases who did not respond to standard external cardiopulmonary resuscitation with advanced life support. Over a perio d of 12 years, OCCPR was performed in 33 patients with out-of-hospital cardiac arrest arising from different causes: after unsuccessful atte mpts to achieve ROSC with CCCPR efforts over 7-121 min (median 25 min) . With OCCPR, ROSC was achieved in 13/33 patients. Of these, two recov ered to discharge (one with no neurological deficit and one with mild brain damage). The other 11 rearrested either in the emergency departm ent after a median period of 70 min of resuscitation, or in the intens ive care unit after a median period of 104 h. One case of iatrogenic c ardiac injury was observed. The OCCPR attempts were well accepted by t he public. Our data suggest that OCCPR is more effective than CCCPR in achieving ROSC outside hospital in patients with major cardiac diseas e and prolonged arrest. OCCPR is feasible in the out-of-hospital setti ng. Survival without neurological deficit cannot be expected when CCCP R with no-flow is continued beyond 25 min. (C) 1997 Elsevier Science I reland Ltd.