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August 21, 1967

Successful Cardiac Massage, Open and Closed

JAMA. 1967;201(8):639. doi:10.1001/jama.1967.03130080081027

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To the Editor:—  Shocket and Rosenblum present a most provocative account of successful open cardiac massage following unsuccessful closed-chest cardiopulmonary resuscitation in The Journal (200: 333, 1967). They reported that "75 minutes of closed-chest massage sustained but failed to resuscitate a 32-year-old patient." This report among others demonstrates the need for high standards in closed-chest cardiopulmonary resuscitation. The authors report a common cause of failure in closed-chest cardiopulmonary resuscitation, that of inadequate attention to detail. Success requires prompt and adequately performed emergency measures ( for sustaining life ) and specific therapy for resuscitation, per se. The National Research Council has approved the high standards of both emergency and definitive therapy outlined by the American Heart Association's Committee on Closed-Chest Cardiopulmonary Resuscitation (198:372, 1966).Repeated administration of epinephrine at intervals of five minutes is strikingly effective in increasing perfusion pressure and, more importantly, the vigor of ventricular fibrillatory activity. The latter is