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January 19, 1957


Author Affiliations


From the Clinic of Surgery, National Heart Institute, and the Department of Surgery, the Johns Hopkins University and Hospital. Dr. Kay is now at the University of Southern California School of Medicine, Los Angeles; Dr. Dever at the University of Miami School of Medicine, Coral Gables, Fla.; and Dr. Kaiser at the University of Indiana School of Medicine, Indianapolis.

JAMA. 1957;163(3):165-167. doi:10.1001/jama.1957.02970380007003

• Cardiac arrest occurs in two forms: ventricular standstill and ventricular fibrillation. When it occurs, it is necessary to correct the cause if possible and administer 100% oxygen by positive pressure. Simultaneously a thoracotomy is performed by a left anterior incision extending from the sternum laterally to the midaxillary line, through the fourth intercostal space. Cardiac massage is begun and is applied rhythmically 45 to 50 times per minute. If the heart is beating feebly, manual compressions are timed to reinforce the systole. If good ventricular contractions are not obtained within a few seconds, the pericardium is opened and the manual systoles are continued with the exposed heart. Epinephrine, 1:10,000 injected into the left ventricular cavity, with certain precautions, is the most effective stimulant. If the heart is found to be fibrillating, this must be stopped by single electric shocks using 130 volts for 0.25 second or 220 volts for 0.10 second, after which rhythmical manual compression may be necessary and epinephrine can be given. These recommendations are based on over 350 experiments on cardiac arrest in dogs and on 30 cases of cardiac arrest in patients who were later discharged from the hospital without sequelae.