Resuscitation
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We report echocardiographic observations during external chest compression in a patient with marked abnormalities in thoracic anatomy following emergency surgery of aortic arch aneurysm. Transesophageal echocardiography demonstrated direct right ventricular, aortic and left atrial compression, only minimal left ventricular compression and an open mitral valve during closed chest heart massage. Colour flow doppler demonstrated forward blood flow across the mitral valve and along the left ventricular outflow tract during the compression phase. Echocardiographic findings indicate that factors apart from simple cardiac pump mechanism contributed to blood flow during cardiopulmonary resuscitation (CPR) in this postoperative patient after a major thoracic surgical intervention.
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Comparative Study
Ventilation caused by external chest compression is unable to sustain effective gas exchange during CPR: a comparison with mechanical ventilation.
To compare the tidal volume, minute ventilation, and gas exchange caused by mechanical chest compression with and without mechanical ventilatory support during cardiopulmonary resuscitation (CPR) in a laboratory model of cardiac arrest. ⋯ Standard chest compression alone produced measurable tidal volume and minute ventilation. However, after 10 min of chest compression following 6 min of untreated ventricular fibrillation, it failed to sustain pulmonary gas exchange as indicated by significantly greater arterial and mixed venous hypercarbic acidosis when compared with a group receiving mechanical ventilation.
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Since its introduction into clinical practice in 1988, the laryngeal mask airway (LMA) has fundamentally changed the airway management of patients undergoing routine anaesthesia. Currently in the UK, the LMA is used in > 50% of surgical procedures where an endotracheal tube (ETT) would formerly have been used. It seems timely to review the role of this device in resuscitation and its potential role in the pre-hospital arena.