SINUS STIMULATION AS A FACTOR IN THE RESUSCITATION OF THE HEART.

The four series of experiments described above indicate clearly that tetanic stimulation of the sinus region of the auricles is of material assistance to massage in the resuscitation of the heart. It causes the auricles to generate impulses, either rhythmical or irregular, to which the ventricles, when susceptible, respond. When massage administered for brief periods has failed to resuscitate the heart, the same period of massage combined with tetanic stimulation of the sinus has usually brought the circulation back to normal. In some instances massage alone when continued over long periods has been without effect, and to all appearances would have continued to be without effect, whereas at such a time massage combined with stimulation of the sinus has effected recovery. Whether the stimulus causes the auricles to beat normally or to fibrillate seems to make no essential difference in the end result. Not infrequently conductivity and irritability are lowered to such an extent by the cessation of the circulation, that impulses generated in an auricle started by stimulation can at first manifest no effect upon the ventricles. Under such circumstances massage alone or, more frequently, massage plus stimulation may cause the ventricles to beat with their inherent slow rate. Often then the force of the ventricular contractions is insufficient for the maintenance of an effective circulation. In such cases, however, with the gradual improvement in the condition of the heart, the auricular impulses, as a rule, soon begin to reach the ventricles, with the result that the latter immediately begin to beat more rapidly and effectively. The beneficial results of stimulation of the auricles, therefore, manifest themselves relatively late, but none the less effectively. It has been found that even after the heart has begun to beat, stimulation of the sinus region may still be of some assistance, though in another direction. It not infrequently happens that after resuscitation of the heart the blood pressure fails to rise above a certain low and insufficient level. In such cases repeated tetanic stimulation of the sinus may accelerate the rise of blood pressure and so hasten recovery (protocol of experiment 12, series II, and text-figure 5). No attempt has been made to determine the mechanism of this effect.