Boczar M E, Howard M A, Rivers E P, Martin G B, Horst H M, Lewandowski C, Tomlanovich M C, Nowak R M
Department of Emergency Medicine, Henry Ford Health Systems, Detroit, MI 48202.
Crit Care Med. 1995 Mar;23(3):498-503. doi: 10.1097/00003246-199503000-00014.
To compare the hemodynamics of closed-chest cardiac massage vs. open-chest cardiac massage in patients resuscitated from cardiac arrest that occurred outside of the hospital.
Prospective, non-outcome, case series.
Large urban emergency department.
Ten adult, normothermic, nontraumatic, out-of-hospital, cardiac arrest patients who failed advanced cardiac life support (ACLS) therapy.
Patients presenting to the hospital in cardiac arrest were managed according to the ACLS protocol at the clinician's discretion. Proximal aortic and central venous pressure catheters were placed to measure arteriovenous compression- and relaxation-phase pressure gradients. After 5 mins of baseline measurements during closed-chest cardiac massage, patients underwent a left lateral thoracotomy, and open-chest cardiac massage was performed for 5 mins.
The mean coronary perfusion pressure and compression-phase pressure gradients were 7.3 +/- 5.7 and 6.2 +/- 5.4 mm Hg, respectively, during closed-chest cardiac massage, while increasing to 32.6 +/- 17.8 and 32.6 +/- 29.9 mm Hg, respectively, during open-chest cardiac massage. The differences between both measurements were statistically significant (p < .05).
Open-chest cardiac massage is superior to closed-chest cardiac massage in providing relaxation-phase and compression-phase pressure gradients during cardiac arrest in patients failing current ACLS protocols. During open-chest cardiac massage, all patients exceeded the minimum coronary perfusion pressure of 15 mm Hg, which is recommended to obtain a return of spontaneous circulation. Further outcome studies are needed to determine the timeliness and appropriate indications for open-chest cardiac massage.
比较在院外发生心脏骤停后接受复苏的患者中，闭胸心脏按压与开胸心脏按压的血流动力学情况。
前瞻性、非结果性病例系列研究。
大型城市急诊科。
10例成年、体温正常、非创伤性、院外心脏骤停且高级心脏生命支持（ACLS）治疗失败的患者。
心脏骤停后送至医院的患者由临床医生酌情根据ACLS方案进行处理。放置近端主动脉和中心静脉压力导管以测量动静脉压缩期和舒张期压力梯度。在闭胸心脏按压期间进行5分钟基线测量后，患者接受左外侧开胸手术，并进行5分钟的开胸心脏按压。
闭胸心脏按压期间，平均冠状动脉灌注压和压缩期压力梯度分别为7.3±5.7和6.2±5.4 mmHg，而在开胸心脏按压期间分别增至32.6±17.8和32.6±29.9 mmHg。两种测量结果之间的差异具有统计学意义（p<0.05）。
对于目前ACLS方案治疗失败的心脏骤停患者，开胸心脏按压在提供舒张期和压缩期压力梯度方面优于闭胸心脏按压。在开胸心脏按压期间，所有患者均超过了推荐的获得自主循环所需的最低冠状动脉灌注压15 mmHg。需要进一步的结局研究来确定开胸心脏按压的及时性和适当适应症。
