External Cardiac Massage

Baringer,; Ew, Salzman; Wa, Jones; Al, Friedlich

doi:10.1056/nejm196107132650203

Cited by 141 publications

(29 citation statements)

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“…B. bei Wirbels~ulentuberkulose (Gleason und Aufderheide, 1953). In unterschiedlicher Frequenz werden KME auch nach extrathorakaler Herzmassage beobachtet; die Zahlen variieren zwischen 13 % (Baringer et al, 1961) und nahezu 100 % (Yanoff, 1963). -Bereits Ogata (1912) dachte daran, da6 nicht unbedingt eine Knochenfraktur Voranssetzung sein mtisse ffir das Zustandekommen der pulmonalen KME, sondern lediglich isolierte Zerreit~ungen im blutbildenden Mark.…”

Section: Intraalveoldres Und Septales Lungenodem Mikrohdmorrhagien unclassified

Vitale Reaktionen in der Lungenstrombahn bei Tod durch Strangulation

Brinkmann

1978

Z Rechtsmed

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Vital Reactions of the Pulmonary Circulation in Fatal StrangulationSummary. Morphological examinations in 34 fatal strangulations. Thirty cases were caused by hanging, 2 by strangulation by ligature, 2 by throttling. The age of the victims ranged between 6 and 86. Extensive documentation of pathological findings with special contribution to signs of strangulation and suffocation. Histological examinations of the lungs in each case. In a first series of ten cases 5 to 7 tissue specimens from different lobes were investigated after routine HEstaining. In the second series of 24 cases 10 to 15 tissue samples were subjected to Giemsa-dyeing. Additional special stains were performed on about 30 % of all paraffin blocks in a second step. These included: Pappenheim, HE or Giemsa (depending on the series' routine stainings), PTAH, Mallory, Masson-Goldner, ~-naphthole-esterase, naphtole-AS-D-Cl-esterase and toluidineblue on semi-thinsections. Furthermore 3 to 6 specimens per case were subjected to sudan-staining. The most important results were: Nearly all cases showed intraalveolar edema and hyperemia usually combined with micro-hemorrhages as well as unequal emphysema of the lungs. The contents of the small arteries and arterioles were regularly altered in varying degrees and patterns. All cases showed an increase of intravascular bone marrow cells either scattered diffusely between erythrocytes or arranged to aggregates. Most of the mononuclear cells gave strongly positive N-AS-D-Cl-esterase reactions, showing that they belonged to the myelopoetic system. Additional admixtures of young and adult leucocytes were also encountered in the altered vessels as well as platelet aggregates. Three cases showed pulmonary embolism of small tissue pieces consisting of bone marrow. There were minor degrees of fat embolism in nine cases usually with fat droplets only in a few vessels. With regard to the small number of cases it is tentatively suggested, that the degree of microembolism is diminishing in the elderly age groups. The vascular walls show edema and swelling and vacuolar degeneration of the endothelial cells. The observed changes are considered to have resulted from vital reactions to strangulation. Since skeletal injuries were carefully excluded it is suggested, that bone marrow embolism was due to marrow fractures following the suffocation convulsions. The release of immature and young bone marrow cells could be partly due to intramedullary pressure changes and to hypoxic damages of the endothelial cells of the sinusoids and to direct effects of humoral substances that are increased in shock.

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Section: Intraalveoldres Und Septales Lungenodem Mikrohdmorrhagien unclassified

Vitale Reaktionen in der Lungenstrombahn bei Tod durch Strangulation

Brinkmann

1978

Z Rechtsmed

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“…The technique was quickly accepted and its efficacy documented in clinical reports. 2 However, early hemodynamic observations during experimental CPR by Weale and Rothwell-Jackson' showed that chest compression resulted in an equal increase in arterial and venous pressures recorded in the iliac vessels, and the absence of a significant pressure gradient was believed to argue against antegrade flow. The absence of an arteriovenous pressure gradient to account for forward flow was confirmed in human subjects by MacKenzie et al 5 These investigators found that right atrial pressure increased to a level equal to that of the systemic arterial pressure and suggested that the equivalent pressure increase in the right atrium and arterial bed could result in retrograde flow or reflux into the extrathoracic venous bed.…”

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confidence: 99%

Pressure-synchronized cineangiography during experimental cardiopulmonary resuscitation.

Niemann¹,

Rosborough²,

Hausknecht³

et al. 1981

Circulation

160

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SUMMARY Cardiopulmonary resuscitation (CPR) has been thought to produce blood flow by compression of the heart between the sternum and spine, termed "external cardiac massage," but there has been-no direct experimental documentation of this proposed mechanism.Micromanometric pressure recordings were synchronized with cineangiograms during mechanical CPR in 17 dogs with induced ventricular fibrillation. Chest compression produced equivalent pressure increases in the aorta (Ao) and right atrium (RA) (Ao 32 + 14 mm Hg, RA 30 ± 14 mm Hg; NS), a linear relationship between aortic and intrapleural pressures (r = 0.87, p < 0.001) over a wide range of induced pressures, cineangiographic blood flow through both left-heart chambers, and a pressure gradient (21 ± 14 mm Hg) between all intrathoracic cardiovascular compartments and the jugular veins that resulted from closure of venous valves at the thoracic inlets. Simultaneous chest compression and lung inflation significantly increased all intrathoracic vascular pressures, the aortojugular venous gradient (42 ± 13 mm Hg, p < 0.05 vs chest compression alone), electromagnetically determined carotid arterial blood flow (1.75 ± 0.81 ml/min/kg vs 0.51 ± 0.27 mI/min/kg during chest compression alone, p < 0.005), and angiographic left-heart flow.We conclude that blood flow during CPR results principally from an increased intrathoracic pressure and that there is selective flow to the brachiocephalic vascular bed because of the arteriovepous gradient produced by venous valves at the thoracic inlets. Greater intrathoracic pressure resulting from simultaneous inflation and compression improves left-heart flow. The left heart is therefore a conduit, not a pump, during CPR.THE ABILITY of closed-chest cardiopulmonary resuscitation (CPR) to produce an arterial pulse and perfuse vital organs in the arrested circulation was demonstrated experimentally and clinically in 1960 and termed "external cardiac massage."' As the name implied, the technique was thought to produce selective ventricular compression between the sternum and spine, propelling blood forward through the systemic vasculature. The technique was quickly accepted and its efficacy documented in clinical reports.2However, early hemodynamic observations during experimental CPR by Weale and Rothwell-Jackson' showed that chest compression resulted in an equal increase in arterial and venous pressures recorded in the iliac vessels, and the absence of a significant pressure gradient was believed to argue against antegrade flow. right atrium and arterial bed could result in retrograde flow or reflux into the extrathoracic venous bed. Rudikoff and co-workers" showed the absence of a significant net aortic-central venous pressure gradient during chest compression and documented that the pressures in all cardiac chambers and in the thoracic aorta increase proportionately with the increase in intrapleural pressure. These findings suggest that vascular pressures and flow recorded during chest compression are dependent upon the generated i...

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“…Four years later, Kouwenhoven et al [8] described the closed-chest cardiac massage and postulated that patients recovered faster with this technique. Other reports which demonstrating the efficiency of the closed-chest technique also published in the ensuing three years, nonetheless Baringer et al [9] and Portal et al [10] reported some complications related to the closed technique such as rib fracture, hemothorax, hemopericardium, hepatic injury and bone marrow embolism.…”

Section: Discussionmentioning

confidence: 96%

Diffuse hepatic hemorrhage in a patient undergoing emergency conventional coronary artery bypass surgery following cardiopulmonary resuscitation

Müdüroğlu¹,

Çayır²,

Yüksel³

2017

Blood Heart Circ

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A 71-year-old male patient was admitted with a diagnosis of acute myocardial infarction, he underwent an urgent coronary angiography and stent implantation to a totally occluded circumflex coronary artery. During the percutaneous coronary intervention, cardiac arrest occurred and a short-lived and successful mechanical and medical cardiopulmonary resuscitation was applied. Once a satisfactory cardiac rhythm and arterial blood pressure were obtained, the patient underwent coronary artery bypass surgery on an emergency basis. During the operation, a high volume of intraabdominal hemorrhage secondary to hepatic injury was observed following additional exploratory laparotomy. We performed perihepatic packing for diffuse hepatic hemorrhage, since there was no particular focus of bleeding or rupture in the liver. In spite of accurate and sufficient fluid and blood product replacement, the patient died on account of hypovolemic shock. This report highlights the possibility of diffuse hepatic hemorrhage secondary to liver injury related to cardiopulmonary resuscitation.

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External Cardiac Massage

Cited by 141 publications

References 0 publications

Vitale Reaktionen in der Lungenstrombahn bei Tod durch Strangulation

Vitale Reaktionen in der Lungenstrombahn bei Tod durch Strangulation

Pressure-synchronized cineangiography during experimental cardiopulmonary resuscitation.

Diffuse hepatic hemorrhage in a patient undergoing emergency conventional coronary artery bypass surgery following cardiopulmonary resuscitation

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