Minimally invasive direct cardiac massage versus closed-chest cardiopulmonary resuscitation in a porcine model of prolonged ventricular fibrillation cardiac arrest

Open chest cardiac massage has been shown to be superior to closed-chest ca rdiopulmonary resuscitation for both hemodynamics produced during resuscita tion and ultimate resuscitation success. The inexperience of many rescuers with emergency thoracotomy, along with the associated morbidity contributes to the continued reluctance in the use of invasive cardiopulmonary resusci tation techniques. A device has been developed for performing 'minimally in vasive' direct cardiac massage. This technique was compared to standard clo sed-chest CPR for resuscitation results in 20 swine during prolonged ventri cular fibrillation cardiac arrest. Minimally invasive direct cardiac massag e was superior to closed-chest CPR for return of spontaneous circulation (7 /10 vs. 2/10; P < 0.02) and coronary perfusion pressure at 30 min of CPR (1 7 +/- 9 vs. 6 +/- 6 mmHg; P < 0.05). No significant injuries altering outco me were found with the invasive device. Throughout most of the time course of the study no significant differences in end-tidal expired carbon dioxide levels were noted. Nor were there any differences in 24-h survival. Improv ements in assuring proper placement of the device on the epicardium should make this technique a potent advanced cardiac life support adjunct. (C) 200 0 Elsevier Science Ireland Ltd. All rights reserved.