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May 29, 1967

Technique of Compression in Closed-Chest Cardiac Massage

Author Affiliations

From the Department of Medicine, State University of New York at Buffalo and the Buffalo General Hospital, Buffalo.

JAMA. 1967;200(9):793-795. doi:10.1001/jama.1967.03120220095023

THE SUCCESSFUL reversal of cardiac arrest by cardiopulmonary resuscitation has been well documented. The controversal question of whether external or internal cardiac massage is more effective has still not been solved. Recent evidence favors the use of open-chest cardiac massage if appropriaate facilities are available and the patient has not responded to 10 to 15 minutes of closed-chest massage.1 Higher cardiac output with open-chest resuscitation has been shown in animals2 as well as man.3 The difference in part may be due to the lower mean arterial pressure obtained with external cardiac massage. With cardiac arrest and cessation of circulation, there is a sudden rise of venous pressure and a similar fall in arterial pressure so that the two equilibrate at 20 to 25 mm Hg.1 If cardiac output is to follow traditional pressure flow relationships (flow = pressure/resistance) the mean arterial pressure must be higher than 25

Harley, H.R.S.:  Reflections on Cardiopulmonary Resuscitation ,  Lancet 2:1-4 ( (July 2) ) 1966.Crossref
Weiser, F.M.; Adler, L.N.; and Kuhn, L.A.:  Hemodynamic Effects of Closed and Open Chest Cardiac Resuscitation in Normal Dogs and Those With Acute Myocardial Infarction ,  Amer J Cardiol 10:555-561 ( (Oct) ) 1962.Crossref
DelGuercio, L.R.M., et al:  Comparison of Blood Flow During External Cardiac Massage in Man ,  Circulation 31 ( (suppl 1) ):171-180 (April) 1965.
DelGuercio, L.R.M.; Coomaraswamy, R.P.; and State, D.:  Cardiac Output and Other Hemodynamic Variables During External Cardiac Massage in Man ,  New Eng J Med 269:1398-1404 ( (Dec 26) ) 1963.Crossref
Jude, J.R.; Kouwenhoven, W.B.; and Knickerbocker, G.G.:  Cardiac Arrest: Report of Application of External Cardiac Massage on 118 Patients ,  JAMA 178:1063-1070 ( (Dec 16) ) 1961.Crossref
Birch, L.H., et al:  A Study of External Cardiac Compression ,  J Mich Med Soc 61:1346-1352 ( (Nov) ) 1962.