Commotio cordis: Another cardiac arrest "sine materia". The 1707 early report and interpretation by G.M. Lancisi.

Sudden death by commotio cordis is rare. It is the consequence of a blunt trauma of the chest overlying the heart. The mechanism is a cardiac arrest by ventricular fibrillation in the absence of grossly or microscopically apparent myocardial injury. It has been reproduced in animals. The first historical case was reported by Giovanni Maria Lancisi in his book "De Subitaneis Mortibus'' published in 1707. Sudden death occurred in a man receiving a powerful blow under the xiphoid cartilage. Lancisi advanced the hypothesis of acute heart failure by a diastolic stand still ("death in diastole'').

Narrative ethics, authentic integrity, and an intrapersonal medical encounter in David Foster Wallace's "luckily the account representative knew CPR".

In Wallace's short story "Luckily the Account Representative Knew CPR," a vice president (VP) suffers cardiac arrest. As an account representative (AR) administers CPR, he discovers his own impersonality mirrored back to him by the VP-a disturbing vision of himself that the AR wishes to escape. Because modern moral theories would have the AR respond impersonally to the VP, those theories would only exacerbate his existential predicament. In contrast, by regarding the AR's act as one that he, in particular, should perform, narrative ethics can discern a resolution for his predicament: because the AR still values his diminished capacities for care and spontaneity, this situation offers him an opportunity to revive those former traits. Doing so would give him greater authentic integrity, or narrative continuity with the most important aspects of his past. Authentic integrity can serve narrative ethics as a helpful starting point for understanding how the life stories of patients, clinicians, and others might appropriately unfold.

From clinical judgment to odds: a history of prognostication in anoxic-ischemic coma.

Persistent coma from a major anoxic-ischemic injury to the brain may indicate there is less chance for full recovery. The tools of prognostication to assess comatose survivors of cardiopulmonary resuscitation have developed over several decades. Physicians would initially base their judgment on experience and data on outcome in these patients in the early years were merely on awakening not on disability. In the late 1970s, a large multicenter prospective study was performed on outcome in nontraumatic coma. The impetus for this study was the result of Plum and Jennet's collaboration. In 1981--for the first time--complex statistics were used to improve the accuracy of prognosis and became known as the "Levy algorithms." These early seminal studies shaped the prediction models and implied that clinical information alone could assist physicians in making a prediction. Later, probabilistic methods became more commonplace.

Medicinal brandy.

This paper describes the use of brandy and other forms of alcohol in the latter part of the 19th and early 20th centuries. Its prime use was as a cardiac stimulant as it seemed to increase the cardiac output and blood pressure. However it was also recognised as a depressant and was used as a sedative. Reconciling these two actions caused difficulties. In addition it was used as a food for invalids.

[Resuscitation by direct heart massage in the history of surgery and anesthesia of Bjelovar hospital]. / Reanimacija izravnom masazom srca u povijesti kirurgije i anestezije bjelovarske bolnice.

This historical review presents cases of direct heart massage in patients with intraoperative cardiac arrest performed at Department of Surgery, Bjelovar General Hospital. Out of five cases recorded in the 1960-1970 period, resuscitation proved successful in two patients, but one patients living normal life free from any subsequent complications. The patient critical general condition, comorbidities and anesthesiology incidents as the possible causes of cardiac arrest are discussed, and the staffing and logistic problems encountered in a small-town hospital are presented.

History and current trends in sudden cardiac arrest and resuscitation in adults.

Cardiac arrest occurs when organized cardiac contractility ceases and circulation stops. During cardiac arrest, electrical activity may be abnormal or absent, and the rhythm documented can be ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity, or asystole. It has been estimated that 300 000 sudden cardiac arrests occur each year in the United States, with 75% (225,000) occurring out-of-hospital and 25% (75,000) occurring in-hospital. A similar number occur in Europe each year. The 3-phase model of cardiac arrest, which proposes that a cardiac arrest progresses through distinct phases as time elapses, helps inform research and clinical care by providing a framework for improving outcomes from cardiac arrest. Early in an arrest, during the electrical phase, defibrillation is paramount. The circulatory phase begins after 4 to 5 minutes, and interventions to optimize circulation become of primary importance. When an arrest is prolonged, lasting for ≥10 minutes, the patient passes into the metabolic phase, in which significant metabolic derangements have accrued and start to dominate arrest physiology. If return of spontaneous circulation occurs during this phase, significant injury to diverse organs may have occurred, producing a critical illness known as post-cardiac arrest syndrome. The post-cardiac arrest syndrome has been recognized as a unique entity requiring unique therapies for successful management. Recent advances in cardiac arrest care include cardiocerebral resuscitation and the use of therapeutic hypothermia to treat comatose survivors of cardiac arrest.

Some prehistory of New Zealand intensive care medicine.

In taking 1960 as the foundation year for the practice of intensive care medicine in New Zealand, this paper briefly looks into the previous two centuries for some interventions in life-threatening conditions. With the help of descriptions in early 19th century journals and books by perceptive observers, the author focuses on some beliefs and practices of the Maori people during pre-European and later times, as well as aspects of medical treatment in New Zealand for early settlers and their descendents. Dr Laurie Gluckman's book Tangiwai has proved a valuable resource for New Zealand's medical history prior to 1860, while the recent publication of his findings from the examination of coroners' records for Auckland, 1841 to 1864, has been helpful. Drowning is highlighted as a common cause of accidental death, and consideration is given to alcohol as a factor. Following the 1893 foundation of the New Zealand Medical Journal, a limited number of its papers which are historically relevant to today's intensive care are explored: topics include tetanus, laryngeal diphtheria, direct cardiac massage, traumatic shock, thiopentone management for fitting and the ventilatory failure due to poliomyelitis.

A história da ressuscitação cardiopulmonar no Brasil / Cardiopulmonary resuscitation history in Brazil

Justificativa e objetivos: A documentação da história da ressuscitação cardiopulmonar tem sido extensa em todo mundo. A despeito disto, no Brasil, carece ainda de artigos históricos que apresentem, de forma adequada, esta documentação; artigos esparsos e relatos pessoais têm composto a maioria das evidências, que ainda pouco documenta o real valor de diversos pioneiros na divulgação deste conhecimento no país. Conteúdo: Foram selecionados 37 artigos, capítulos de livros nas bases de dados SciElo e LILACS (1969-2009), por meio das palavras-chave: ressuscitação cardiopulmonar, parada cardiorrespiratória, parada cardíaca, história e Brasil. Nenhum artigo foi encontrado na MedLIne. Adicionalmente, referencias desses artigos, capítulos de livros e artigos históricos foram fornecidos pelo arquivo pessoal dos próprios autores e avaliados. São apresentados os dados de artigos, sem a interferência direta da analise pessoal dos autores. Conclusão: O pioneirismo e a persistência de diversos profissionais da saúde no país conseguiram disseminar o conhecimento da ressuscitação cardiopulmonar na área continental do Brasil. Em seu desafio de educar médicos, socorristas e a população em geral, certamente pelos esforços e pioneirismo descritos, estes profissionais já deixaram sua marca na história da Medicina brasileira.

Background and objectives: The documentation about the cardiopulmonary resuscitation history has been sufficiently extensive around the world. The spite of this, the documentation, in Brazil, still lacks of historical articles that present of adequate form this documentation; rarely articles and personal stories have composition the majority of the evidences that little register the real value of several pioneers in the spreading of this knowledge around the country. Contents: 37 articles had been selected, book chapters in the databases of SciElo and LILACS (1969-2009), by means of the keywords: cardiopulmonary resuscitation, cardiopulmonary arrest, cardiac arrest and history in Brazil. Neither article was found in the Medline. Additionally, references of these articles, historical book chapters and articles had been supplied by the personal archives of the authors that evaluated. The data are presented, without the direct interference analyzed of the authors. Conclusion: The pioneirism and persistence of many health providers in the country in order to spread the knowledge of the cardiopulmonary resuscitation in the continental area of Brazil is described. In their challenge of education of medical, paramedical and population in resuscitation, certainly the pioneer efforts here described, have left a permanent mark in the history of medicine in Brazil.

Cardiopulmonary resuscitation: from the beginning to the present day.

Cardiac arrest represents a dramatic event that can occur suddenly and often without premonitory signs, characterized by sudden loss of consciousness and breathing after cardiac output ceases and both coronary and cerebral blood flows stop. Restarting of the blood flow by cardiopulmonary resuscitation potentially re-establishes some cardiac output and organ blood flows. This article summarizes the major events that encompass the history of cardiopulmonary resuscitation, beginning with ancient history and evolving into the current American Heart Association's commitment to save hearts.

Therapeutic hypothermia: applications in pediatric cardiac arrest.

There is a rich history for the use of therapeutic hypothermia after cardiac arrest in neonatology and pediatrics. Laboratory reports date back to 1824 in experimental perinatal asphyxia. Similarly, clinical reports in pediatric cold water drowning victims represented key initiating work in the field. The application of therapeutic hypothermia in pediatric drowning victims represented some of the seminal clinical use of this modality in modern neurointensive care. Uncontrolled application (too deep and too long) and unique facets of asphyxial cardiac arrest in children (a very difficult insult to affect any benefit) likely combined to result in abandonment of therapeutic hypothermia in the mid to late 1980s. Important studies in perinatal medicine have built upon the landmark clinical trials in adults, and are once again bringing therapeutic hypothermia into standard care for pediatrics. Although more work is needed, particularly in the use of mild therapeutic hypothermia in children, there is a strong possibility that this important therapy will ultimately have broad applications after cardiac arrest and central nervous system (CNS) insults in the pediatric arena.

Emergency suboccipital decompression for respiratory arrest during supratentorial surgery: the untold story of a surgeon's courage in times of despair.

The odyssey leading to the discovery of herniation syndromes was prolonged due to a lack of early understanding of the underlying pathophysiology. In 1896, Leonard Hill documented transtentorial pressure gradients as the intervening phenomenon involved in uncal herniation. In 1904, James Collier became the first to describe cerebellar tonsillar herniation as a "false localizing sign" often associated with intracranial tumors. During the infancy of neurological surgery, management of increased intracranial pressure and an improved understanding of brain herniation syndromes were of the utmost importance in achieving a safe technique. Harvey Cushing provided seminal contributions in understanding the pathophysiology of increased intracranial pressure and resulting cardiopulmonary effects. Cushing believed that tonsillar herniation was a cause of acute cardiorespiratory compromise in patients with intracranial tumors. In this vignette, we describe the untold story of Cushing's heroic attempt to treat respiratory arrest operatively during supratentorial tumor surgery with an emergency suboccipital craniectomy to relieve the medullary dysfunction that he believed was caused by compression from tonsillar herniation. This case illustrates a surgeon's determination and courage in fighting for his patient's life in the most desperate of times.