A TECHNIQUE REVISITED - HEMODYNAMIC COMPARISON OF CLOSED-CHEST AND OPEN-CHEST CARDIAC MASSAGE DURING HUMAN CARDIOPULMONARY-RESUSCITATION

Objective: To compare the hemodynamics of closed-chest cardiac massage vs, open-chest cardiac massage in patients resuscitated from cardiac arrest that occurred outside of the hospital. Design: Prospective, non -outcome, case series. Setting: Large urban emergency department. Pati ents: Ten adult, normothermic, nontraumatic, out-of-hospital, cardiac arrest patients who failed advanced cardiac Life support (ACLS) therap y. Interventions: Patients presenting to the hospital in cardiac arres t were managed according to the ACLS protocol at the clinician's discr etion, Proximal aortic and central venous pressure catheters were plac ed to measure arteriovenous compression- and relaxation-phase pressure gradients, After 5 mins of baseline measurements during closed-chest cardiac massage, patients underwent a left lateral thoracotomy, and op en-chest cardiac massage was performed for 5 mins. Measurements and Ma in Results: The mean coronary perfusion pressure and compression-phase pressure gradients were 7.3 +/- 5.7 and 6.2 +/- 5.4 mm Hg, respective ly, during closed-chest cardiac massage, while increasing to 32.6 +/- 17.8 and 32.6 +/- 29.9 mm Hg, respectively, during open-chest cardiac massage, The differences between both measurements were statistically significant (p < .05). Conclusions: Open-chest cardiac massage is supe rior to closed-chest cardiac massage in providing relaxation-phase and compression-phase pressure gradients during cardiac arrest in patient s failing current ACLS protocols, During open-chest cardiac massage, a ll patients exceeded the minimum coronary perfusion pressure of 15 mm Hg, which is recommended to obtain a return of spontaneous circulation , Further outcome studies are needed to determine the timeliness and a ppropriate indications for open-chest cardiac massage.