[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.

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.

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.

[Hjalmar Maag: a Danish pioneer]. / Hjalmar Maag - En dansk foregangsmand.

In the year 1900 a young man was on the operating table for a minor operation at the hospital in the small provincial town of Naestved. He was anaesthetized with Chloroform. After 15 minutes his pulse and respiration suddenly failed. All the usual methods of resuscitation were tried, but to no avail. Afterwards a tracheostomy and an inflation with air through the cannula were performed, also without success. The surgeon then decided to open thorax and perform direct internal heat massage. The heart was reactivated and went on working for 8 hours. Dr. Maag did not succeed in saving his patient's life, but he is rightly considered to be the first person to have revived a heart that had completely ceased to work.

From reviving the living to raising the dead; the making of cardiac resuscitation.

Cardiac arrest (the process of the heart ceasing to beat) and cardiac resuscitation (the attempt to restart the heart) were created in the surgical theatres of the early to middle twentieth century, in response to the cardiac arrests which were being caused by the "theatre" doctors themselves. These patients were young and healthy (a consequence of the preselection surgery involves), cardiac resuscitation was trying to revive the living. The paper explores the intimate relationship between cardiac arrest and cardiac resuscitation. By the use of historical and Latourian sociological analysis the paper also reveals how cardiac resuscitation was made into the emblematic medical event it is today, a process which has been so complete that it has become, in many senses, an "obligatory passage point to death", that is, in order to die one must pass through cardiac resuscitation. The outcome of this is the changed nature of cardiac resuscitation, no longer attempting to revive the living, cardiac resuscitation now attempts to raise the dead and dying, and at this it fails. Despite the remarkable success of cardiac resuscitation as a fact, the paper argues that it is a failure as a technique, paradoxically the more successful a fact it became, the more it failed as a procedure. The paper explains this apparent contradiction and the resistance to anomalies, by showing how cardiac resuscitation was created simultaneously inside and outside medical science, from its very start being a social and scientific fact with a vast network of stabilising allies.

Cardiopulmonary resuscitation: a promise as yet largely unfulfilled.

After failure of initial external defibrillation, restoration of spontaneous circulation is largely contingent on rapid and effective reversal of myocardial ischemia by both mechanical and pharmacologic means. Despite the introduction of modern cardiopulmonary resuscitation (CPR) more than 35 years ago, its universal acceptance, and its wide implementation, no improvements in outcome excepting early defibrillation have been documented over these many years. The science of CPR therefore is still in its infancy. It was incorrectly assumed that all that needs to be known is known and that the need for scientific research was therefore not apparent. Accordingly, serious resuscitation research was neither encouraged nor equitably supported. The ABCs of CPR currently provide for the establishment of a patent airway (A) and intermittent positive pressure ventilation, preferably with oxygen-enriched air (B). These are to be immediately followed with precordial compression (C). This ordering of priorities, however, is based on consensus rather than objective outcome measurements. The ABCs recently have been seriously challenged on the basis of results of both experimental and clinical studies. Conventional external precordial compression restores systemic blood flow. It may be used by both professional and nonprofessional CPR providers, especially bystanders, because of its apparent simplicity and noninvasiveness. However, manual or mechanical external precordial compression typically generates cardiac outputs that represent less than 30% of normal values. Coronary blood flow, which is critical for restoration of spontaneous circulation, is correspondingly reduced. Accordingly, several alternatives to conventional precordial compression have been proposed with the intent of increasing cardiac output and both coronary and cerebral blood flows. Among the large number of pharmaceutical agents initially recommended for cardiac resuscitation, only agents that produce peripheral vasoconstriction are of proved benefit. Epinephrine has been the preferred vasopressor agent for the management of cardiac arrest for more than 35 years because of its alpha-adrenergic effects. However, the potentially adverse effects of epinephrine are related to its beta-adrenergic inotropic actions. The beta-adrenergic actions account for disproportionate increases in myocardial oxygen consumption with increased severity of myocardial ischemic injury and provocation of ectopic ventricular tachycardia and ventricular fibrillation. Nevertheless, epinephrine remains the drug of choice, although adrenergic drugs with selective alpha-adrenergic actions or nonadrenergic vasoconstrictor drugs are likely to emerge as useful alternatives. Experimental and clinical observations have led to identification of continuous monitoring of both end-tidal carbon dioxide and ventricular fibrillation waveforms as practical noninvasive guides because they are highly correlated with both cardiac output and coronary blood flow. Both end-tidal carbon dioxide and ventricular fibrillation waveforms now serve as predictors of the likelihood of successful resuscitation. These two measurements may now be used to guide interventions and especially to assure optimal precordial compression. It is well established that sudden death among adults is predominantly due to malignant ventricular arrhythmias and ventricular fibrillation. Early defibrillation serves as an unequivocally effective immediate intervention. Minimally trained first responders and members of the general public are being enfranchised to use automated external defibrillators for very early defibrillation. Use of these devices by bystanders is the most promising new intervention since CPR was first proposed in the early 1960s. Postresuscitation ventricular dysrhythmias and heart failure are now called postresuscitation myocardial dysfunction. This complication has been recognized as a leading cause of the high postresuscitation mor

Conocimiento médico sobre reanimación cardiopulmonar

El estudio es de tipo transversal de cohortes, realizado en marzo de 1995 en los hospitales estatales e IESS de Quito, dirigido a 151 médicos, 14 internos rotativos, 10 estudiantes de 6to años de medicina, con el objeto de determinar los conocimientos sobre reanimación cardiopulmonar básica y avanzada (RCP). El 68.57 por ciento recibieron entrenaminto sobre RCP, de los cuales el 70.83 por ciento recibieron entrenamiento en un hospital, 20 por ciento en la universidad, 7.5 por ciento en clínicas particulares y el 1.66 por ciento no lo indican. Reconocen estar plenamente capacitados el 39.43 plor ciento y el 62.29 por ciento desconocen como utilizar un desfibrilador. Eñl 2.28 por ciento contestan correctamente todo el cuestionario básico, y nadie acierta en la totalidad de las 10 preguntas de reanimación cardiopulmonar avanzada. A pesar de ser un tema prioritario, no sólo para el médico sino para la población en general, los médicos no estamos teóricamente capacitados para dar una RCP adecuada a un paciente en para cardio-respiratorio...