Die äußere Herzwiederbelebung

Zusammenfassung

Die Möglichkeiten zur Behandlung des Herzstillstandes sind durch folgende Methoden erweitert worden: 1. Äußere Herzkompression durch einmal pro Sekunde wiederholten Druck auf das Brustbein ist in der Lage, einen Minimalkreislauf zu unterhalten, wenn der Thorax nicht zu starr ist. 2. Nach mehreren Kompressionen sollte der Sternumdruck kurzfristig unterbrochen werden, um eine Lungeninflation und damit eine Oxygenierung des Blutes — eine unerläßliche Voraussetzung des Erfolges — zu erzielen. — Diese auch außerhalb des Operationssaales, ja außerhalb der Klinik am Unfallort anwendbare Notfallsmethode ist geeignet, ein stillstehendes Herz wieder zu beleben, wie anhand von 222 Fällen von Herzstillstand bei 197 Kranken gezeigt wurde, von denen 117 (53%) wiederbelebt und 47 (24%) geheilt aus der Klinik entlassen werden konnten. — Die äußere Herzmassage stellt keine Konkurrenz, sondern lediglich eine Ergänzung der inneren Herzmassage nach Thorakotomie dar. Diese behält ihren Wert und bleibt indiziert, wenn durch äußeren Sternumdruck kein fühlbarer künstlicher Puls erzeugt werden kann, wenn intrathorakale Nebenverletzungen bestehen oder wenn (bei Kammerflimmern) eine Defibrillierung von außen nicht möglich ist.

Summary

Cardiac Arrest may be defined as “the clinical picture of sudden pulselessness, apnoea and unconsciousness in a patient who was not expected to die.” The treatment of cardiac arrest has been revolutioned by the introduction of closed-chest cardiac massage (external cardiac massage, rhythmic sternal compressions), which has been shown to produce a normal level of systolic arterial pressure even in adults with proven circulatory arrest. Rhythmic sternal compressions cannot be relied upon to ventilate the lungs and, therefore, must be combined with intermittent positive pressure ventilation. Among many possible combinations, four sternal compressions following each lung inflation (or thirty seconds of rhythmic sternal compressions following three to five successive lung inflations) are satisfactory. With ventilation through a cuffed tracheal tube co-ordination is not important. Rapid diagnosis of ventricular fibrillation or asystole and restoration of spontaneous cardiac action are important and may require complex team work. Rhythmic sternal compressions should not be interrupted for more than a few seconds at a time during external defibrillation, intracardiac injections of adrenaline, blood transfusion, searching for a spontaneous pulse, etc. These efforts should be continued until there is a return of a spontaneous beat or evidence of irreversible central nervous system damage. External cardiac resuscitation is not a substitute but a supplementation of direct massage by thoracotomy. The most important aspect of external massage lies in the resuscitation of patients with coronary occlusion outside the hospital. In the hospital, thoracotomy still is indicated when a palpable artificial pulse cannot be felt during sternal compression, when intrathoracic disease is suspected, or when external defibrillation fails. — Sudden and unexpected respiratory and circulatory arrest may be treated anywhere by any trained person, without special equipment. Artificial ventilation can be quickly given by expired-air methods, such as mouth-to-mouth. Blood circulation can be maintained artificially by external cardiac compression through depression of the lower sternum against the heart. These methods have been shown both experimentally and clinically to provide adequate circulation of oxygenated blood to sustain the viability of the vital organs until spontaneous cardiac action can be resumed. — The closed techniques of cardio-pulmonary resuscitation have been used in 222 instances of sudden cardio-pulmonary arrest in 197 persons with a variety of underlying illnesses. In 117 (53%) the pre-arrest condition of the central nervous system and heart were regained; 47 patients (24%) also survived their primary disease and were able to leave hospital. — In those situations where external cardio-pulmonary resuscitation fails to provide an adequate circulation or, in the presence of ventricular fibrillation, an external defibrillator is not available, thoracotomy for direct cardiac massage may be necessary. However, proper application of the external methods and the availability of an external defibrillator now make open thoracotomy seldom necessary.

Resumen

La reanimación cardíaca exterior

Las posibilidades del tratamiento de la parada del corazón han sido ampliadas por los métodos siguientes: 1^° La compresión cardíaca exterior por presión sobre el esternón, repetida una vez por segundo, es capaz de mantener una circulación mínima, si el tórax no es demasiado rígido. 2^° Después de varias compresiones se debería interrumpir la presión sobre el esternón por un plazo breve, a fin de lograr una inflación pulmonar y con ello una oxigenación de la sangre, un supuesto indispensable del éxito. Este método de urgencia, aplicable también fuera del quirófano e incluso fuera de la clínica en el lugar del accidente, se presta para volver a animar un corazón parado, según se mostró a base de 222 casos de parada del corazón en 197 enfermos, de los cuales 117 (= 53%) pudieron ser reanimados y 47 (= 24%) dados de alta en la clínica por haberse curado. — El masaje cardíaco exterior no representa ninguna competencia sino únicamente un complemento del masaje cardíaco interior después de la toracotomia. Este conserva su valor y continúa indicado, si por la presión exterior sobre el esternón no se puede producir un pulso artificial palpable, si existen lesiones secundarias intratorácicas o si no es posible (en caso de fibrilación ventricular) una desfibrilación desde fuera.