[Direct cardiac massage in refractory heart arrest. 2 cases sucessfully treated in the coronary care unit].

The open chest, or direct cardiac massage may be indicate in instances where closed chest techniques are ineffective. Direct cardiac massage was successfully applied by us in two patients who failed to resuscitate with closed chest massage. The patients, an 49 year old man with acute myocardial infarction and an 53 year old man who had a history of previous myocardial infarction with subsequent development of a ventricular aneurysm, had ventricular fibrillation who not responded to closed chest cardiac massage and to repeated electrical countershocks. When the pupils became dilated the decision was made to open the chest and apply direct massage. After several minutes of manual cardiac compression a single D.C. countershock returned the heart to a normal sinus rhythm in each of the patients. Although the thoracotomy was performed outside the operating room, none of the complications of the open chest resuscitation occurred, such as intrathoracic infection, rupture of the heart, and postresuscitative bleeding. The first patient recovered from the infarction, has been discharged from the hospital and is alive and well after 5 months. The second patient has been discharged from the U.C.C. and is alive and well after 15 days.