Canadian Journal of Anesthesia, Vol 6, 75-82, Copyright © 1959 by Canadian Anesthesiologists' Society

Cardiac Resuscitation

¹ Departments of Anaesthesia and Surgery, Vancouver, General Hospital, and the University of British Columbia, Vancouver, B.C.

Need for cardiac resuscitation occurs in approximately 1:1,000 to 1:2,000 surgical procedures. Early recognition by the anaesthetist is important. The surgeon may be required to assist in the diagnosis.

The final diagnosis is best made by observing the heart through a left thoracotomy. The thoracotomy incision should be large, in the fourth left interspace and avoiding the internal mammary artery.

The most common cause is myocardial anoxia with or without reflex activity, anaesthetic agents, or cardiac manipulation.

Early instigation of treatment is important. Respiratory resuscitation should be carried on at the same time as cardiac resuscitation. Cardiac massage is best maintained using two hands and should be started within 4 min. Myocardial tone may be improved using calcium chloride or adrenalin. Ventricular fibrillation is treated by electrical shock, 170–220 v., 1.5 amp., and 0.2 sec.

Defibrillation should not be attempted until the myocardium is oxygenated and the fibrillating movements become coarse. Cardiac massage may be necessary after defibrillation. Cardiac defects such as valvular stenosis should be corrected during massage if possible. All treatment should be aimed at reducing the total time of cerebral anoxia. When resuscitation has been completed, careful post-operative care is necessary.

The best method of treatment is prevention.

Note:

Presented at the Western Divisions' Meeting, Canadian Anaesthetists' Society, Calgary, Alberta, March 13, 1958.