Optimizing myocardial supply/demand balance with alpha-adrenergic drugs during cardiopulmonary resuscitation.

In 14 dogs the determinants of myocardial blood supply and metabolic demands were assessed during cardiopulmonary resuscitation (CPR) and under steady-state conditions in fibrillating hearts on cardiopulmonary bypass. During open chest cardiac massage (nine dogs), coronary diastolic blood pressure and blood flow were low. Vasopressor infusion (methoxamine or epinephrine) raised diastolic pressure from 33 +/- 3 to 55 +/- 3 mm. Hg and increased coronary blood flow (CBF) 124 percent (from 38 +/- 3 to 85 +/- 11 c.c. per 100 Gm. per minute. Comparison of these drugs in fibrillating hearts on cardiopulmonary bypass showed that epinephrine increased the "vigor of fibrillation" (intraventricular balloon pressure rose 24 percent and oxygen uptake increased 42%) but impeded subendocardial flow 53% (endocardial/epicardial flow ratio fell from 0.79 to 0.48). In contrast, methoxamine did not significantly change intraventricular balloon pressure, oxygen uptake, coronary flow, or its distribution. We conclude that augmentation of diastolic pressure with alpha adrenergic drugs during CPR improves coronary perfusion and that inotropic drugs may worsen myocardial ischemia during CPR by raising oxygen demands while simultaneously impeding subendocardial blood supply.

[Postoperative prevention of thrombosis through the tonicizing of the caudal venous system. A new principle of drug therapy]. / Postoperative Thromboseprophylaxe durch Tonisierung des kaudalen Venensystems. Ein neues medikamentöses Behandlungsprinzip

Haemostasis of the lower extremities is among the constituent factors of postoperative thrombosis risks ("Virchow's Trias"). Therapeutical efforts have, therefore, ever since focused on the idea of accelerating vein circulation. An equivalent effect is produced by Dihydergot which is thus qualified for postoperative thrombo-prophylaxis. This investigation proves the efficiency ofDihydergot. Results are based on 148 patients subject to longitudinal section tests along the 125-J-fibrinogen-test lines, from the 1st through to the 6th day after operation. In comparison with a control group, the results with the members of the therapy group gave evidence of a highly significant reduction of thrombosis frequency in the leg veins. Side-effects have not been noted. Tonus of the vessels and acceleration of the vein backflow by Dihydergot form a new therapeutical principle within the scope of postoperative thrombo-prophylaxis. The method is advantageous because it is highly efficient, practicable without complications, and is riskfree.

[Myocardial protective effect using membrane stabilization in ischemic heart arrest in hypothermia]. / Myokardprotektiver Effekt durch Membranstabilisierung bei ischämischem Herzstillstand in Hypothermie.

Membrane stabilization with steroid pretreatment, procaine, or both protect against postischemic left ventricular performance after one hour of topical hypothermic ischemic arrest, but do not prevent myocardial edema. Combining steroids and procaine provide no apparent added benefit, but procaine has the technical advantage of almost immediate cardioplegia.

[Reduction of myocardial reperfusion damage using hypocalcemic, hyperkalemic, alkaline blood during post-ischemic oxygen resaturation]. / Minderung des myokardialen Reperfusionsschadens mit hypocalcämischen, hyperkaliämischen, alkalischem Blut während der postischämischen Wiederaufsättigung mit Sauerstoff.

Postischemic myocardial depression is largely caused by a reperfusion injury which can be avoided almost completely by initial reoxygenation with hypocalcemic, hyperkalemic, alkalotic blood. Reperfusate modification resulted in postischemic myocardial performance comparable to that achieved in hearts receiving continuous coronary perfusion.