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June 22, 1957


JAMA. 1957;164(8):831-836. doi:10.1001/jama.1957.02980080001001

• Experience with anesthesia in all types of surgery has led to the conclusion that the cause of fatalities is to be sought not so much in the chemical identity of any given anesthetic as in errors incidental to its administration. Statistics indicate that card'ac arrest is sufficiently frequent to call for a study of the factors likely to precipitate it. A list of 10 such factors is given, including especially hypoxia, hypercapnia, excessive anxiety in the patient, and errors in dosage. Most of these are preventable by carrying out the protective measures here described. If cardiac arrest occurs it must be treated at once. Thoratocomy by a long intercostal incision in the fourth, fifth, or sixth left interspace should be done quickly to permit maintenance of circulation by direct manual rhythmic compression of the heart through the intact pericardium. Promptness is more important than asepsis, and no intrathoracic infections have been reported in patients who survived such emergency thoracotomies. Artificial respiration by positive prossure must be maintained while the thorax is open. If the heart is found not in a state of asystole but in ventricular fibrillation, rhythmic manual compression must be continued to prevent acute dilatation, but in addition the heart must be brought to a standstill electrically by applying a defibrillating current before there is any possibility of restoring the normal sinus rhythm. The procedures here presented have saved 60% of patients who developed cardiac asystole during anesthesia.