Open Chest Massage in CA Flashcards
First performance of OCCM on dogs - who and when?
Moritz Schiffer in 1874
First OOCPR on person?
Tuffier and Hallion in 1898 (PE patient, survived to die from 2nd CA)
First successful OOCPR?
1901, Ingelsrud - women in CA during elective hysterectomy survived
What 1960 study evidence CPR as we do it now?
Kouwenhoven
Details of OCCM?
Both hands - right on RV, left on LV. Compression between 80-100/minute.
?60-100 due to digital exhaustion.
Current indications for OCCM?
- Cardiac arrest due to trauma.
- Cardiac arest post cardio-thoracic surgery
- If the chest or abdomen is already open.
What happened in 2008 that wasn’t translated to 2015 guidelines?
Interesting to note ILCOR made a suggestion that OC-CPR used if CC-CPR fails in light of the evidence in 2008 - but that’s not in the 2015 guidelines
Define coronary perfusion pressure.
Assessment of the simultaneous difference between aortic and right atrial pressures during diastole or the release phase of compression, when most coronary blood flow has been shown to occur.
Will CPP <15mmHg produce ROSC?
No
What might be better for CCP?
Open Chest Cardiac Massage
Animal studies in OCCM - showed?
- Improved carotid blood flow, systemic arterial pressure, coronary artery perfusion pressure and systemic perfusion.
How to access heart for OCCM?
Left lateral approach: Incision in the 4th IC space from the sternum to mid axillary line… followed by blunt digital dissection of the 4th IC space muscles followed by introcution of a rib spreader …. Once encountered the pericardium it is opened and manual compressions begin..
Midline sternotomy commonly used in post cardiac/ung surfery
When might OCCM be indicated?
If less than 15 minutes after arrest
Why don’t we do OCCM?
- Big change
- Surgical skills
- Infection risk
