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Prolonged respiratory assistance by positive pressure ventilation via cuffed tracheosiomy or endotracheal tube can be complicated by mucosal erosions, tracheal stenosis, tracheomalacia, excavation of the tracheal wall with loss of tissue and tracheœsophageal fistula. Stenosis can occur at the subglottic region, at the stoma, or at the cuff site, whereas the other complications occur most often at the cuff site. This paper is concerned with complications occurring below the first tracheal ring.

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One hundred patients were referred with suspected acute cardiacfailurefollowing acute myocardial infarction. The diagnosis was confirmed in 72: 3I of these patients underwent elective medical treatment, with 2 survivors (6%); 4V were accepted for counterpulsation, but 9 died before this could be initiated and another 2 died shortly after vain attempts to pass the balloon catheter were abandoned; 30 patients underwent counterpulsation with 14 hospital survivors (47%). Survivor status was usually good. Results of counterpulsation were better in patients who were not shocked (with 5/5 survivors) than in those who were in shock (with 9 of 25 survivors). Results support the view that counterpulsation (alone or combined with corrective surgery) may play an important role in the complications of myocardial infarction provided intervention is early.

Thirty-nine patients required heroic resuscitative measures for sudden hypotension and cardiac arrest in the first 72 hours following cardiac surgery between January 1, 1984 and May 31, 1988. Emergency sternotomy with open cardiac compression was performed in twenty-four of these patients when external cardiac compression failed. These were categorised as Group A. Group B comprised the fifteen patients in whom resuscitation was entirely by means of external compression and adjuvant measures. Survival with NYHA Functional Class I and II status was noted in 75% of patients in Group A, compared with 20% in Group B (P <0.002). Emergency sternotomy with open cardiac compression is an effective way of resuscitating patients in the intensive care unit in the first few days following open heart surgery.

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