Prehospital use of minimally invasive direct cardiac massage (MID-CM): a pilot study

Background: Internal cardiac compressions are more efficient than closed ch est compressions (CCC) in cardiac arrest (CA). Aim of the study: To evaluat e the prehospital feasibility of performing a new method of minimally invas ive direct cardiac massage (MID-CM (R) TheraCardia Inc.). Methods: Prospect ive non-randomized open study, after ethical committee approval. Inclusion of 18-85 years old patients in witnessed CA if BLS > 5 min and unsuccessful ACLS > 20 min after CA. The MID-CM is an atraumatic manual cardiac pumping system deployed in the thoracic cavity through a small incision. Evaluatio n of: ease of insertion and performing MID-CM, complications. end-tidal CO2 (PETCO2), non invasive arterial blood pressure (NIBP) and return of sponta neous circulation (ROSC). Values are mean +/- SD (min-max). Results: Twenty -five patients included. Mean age 59 +/- 16 years (26-85): BLS started at 8 +/- 5 min (0-20), compressions started at 47 +/- 10 min (29-74) after CA. Dissection and insertion was fast and easy ( < 1 min). Deployment of the MI D-CM was difficult in two patients because of pericardium adhesions and car diomegaly. In six patients compressions were more difficult because of a 's tone heart' phenomenon. Compressions were possible during ambulance transpo rt of four patients. There was a good palpable carotid pulse in all patient s receiving internal compressions. There was a trend in increase of PETCO2 compared to CCC. NIBP could be measured during MID-CM compressions in 9 pat ients (systolic > 85 mmHg). never during CCC. Seven patients had a ROSC, bu t only four patients were admitted alive. There was no long term survival. One patient had a serious complication (heart rupture). Discussion: Prehosp ital use of MID-CM is possible, but it is not comparable to any other resus citation technique. Training of medical teams is mandatory to obtain good s kills and to avoid complications. Further studies are necessary to evaluate efficiency and survival compared to closed chest compressions. (C) 2001 El sevier Science Ireland Ltd. All rights reserved.