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March 5, 1982

On Closed-Chest Cardiac Resuscitation

JAMA. 1982;247(9):1276. doi:10.1001/jama.1982.03320340034020

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To the Editor.—  Chandra et al, in their article "Abdominal Binding During Cardiopulmonary Resuscitation in Man" (1981;246:351), have discussed closed-chest cardiac resuscitation.The subject of closed-chest cardiopulmonary resuscitation (CPR) has been obscured by two circumstances: (1) the widespread conviction that closed-chest CPR cannot harm, but might help, patients, and (2) the combining of a ventilatory procedure of established merit with a circulatory procedure that causes serious risk and possesses dubious efficacy. Let us examine these circumstances.Two current tacit assumptions are that "cardiac arrest" is never erroneously diagnosed and that closedchest cardiac resuscitation could not conceivably be lethal—because without it, the patient already is dead and hence nothing can be lost by trying any measures to resuscitate him. Although other physicians may accept these assumptions, neither assumption uniformly parallels my experience.Control ventilation, preferably with extra oxygen, often greatly helps patients. Admittedly, gastric pressurization, regurgitation, and aspiration do happen and