Indications and techniques for performing direct cardiac massage

From this article you will learn: what is direct heart massage( abbreviated PMS), who and in what conditions can it carry out.

Direct cardiac massage is one of the resuscitation measures that is designed to restore spontaneous circulation in a person with cardiac arrest. Its essence consists in direct compression of heart by hands through an incision of the thorax or abdomen. In the latter case, massage is carried out through the diaphragm.

It can be performed only by qualified physicians and only under certain conditions - for example, during surgical interventions on the thoracic or abdominal organs. PMS is not included in basic resuscitation measures, which can be carried out by people without medical education.

In conditions where it is possible to perform direct cardiac massage, this technique shows a higher efficacy compared with traditional chest compressions. The exact success rates depend on the reasons for stopping the heart muscle.

PMS effectiveness

Direct cardiac massage was performed in hospitals until the 1960s quite often, and then the concept of traditional chest compressions( KGC) was developed. Until that time, a number of scientific studies of the effectiveness of ICP have been carried out. For example, in 1953, survey data were published, including 1,200 cases of intra-hospital cardiac arrest, in which direct massage was performed. The efficiency of its implementation and recovery rate was 28%.In 1956, a study was published in which the cardiac muscle stasis was studied in the Massachusetts Hospital for 30 years( 1925-1954).In patients who started direct massage within 4 minutes, 58% of the cases were recovered. These indicators are much better than the results of indirect massage, which, despite the achievements of medicine in the intensive care and intensive care industry, can not boast of such efficacy.

These differences are explained by the fact that using PMS can achieve much better blood flow in the coronary arteries. Scientific studies have demonstrated that he can provide coronary perfusion pressure at a level of 32.6 ± 17.8 mm Hg.and traditional KGC - only 7.3 ± 5.7 mm Hg. Art. It is the indicator of coronary perfusion pressure that is of great importance for the resumption of spontaneous circulation - the higher it is, the greater the chances of revitalizing the victim.

Indirect cardiac massage - an alternative to direct cardiac massage

Place of PMS in modern cardiopulmonary resuscitation

Currently, PMS is performed only in medical institutions if patients have cardiac arrest and if the following conditions exist:

Other possible indications for PMS include abnormal chest anatomy that prevents traditional indirect massage, cardiac muscle arrest due to hypothermia, massive air embolism, ineffectiveness of traditional cardiopulmonary resuscitation.

Conducting PMS in out-of-hospital settings and people without medical education is strictly prohibited.

Technique of performing

. As with traditional cardiopulmonary resuscitation, with direct cardiac massage, early onset of the procedure is very important. If there is direct access to the organ through the incision of the thorax or abdomen at the time of the circulatory arrest, the physician can immediately proceed with the PMS.

If during such a cardiac arrest there is no such access, but a decision is made to perform a direct massage, the doctor cuts the wall of the chest through 5 intercostals from the middle axillary line to the sternum and raises the wound with a special instrument.

Direct heart massage is performed with one or two hands. The doctor squeezes it in the direction from the ventricles to the vessels emerging from them, as if squeezing blood. The frequency of such compression, as well as indirect massage, is about 100 per minute. The duration of PMS and indications for its discontinuation are the same as in traditional cardiopulmonary resuscitation.

Surgical access to the heart for its direct massage. Click on photo to enlarge

Forecast

The prognosis for ICP is dependent on the cause of the circulatory arrest and the timing of its onset. Exact figures, except those listed above, are difficult to describe, as this method of resuscitation is currently used very rarely.

One of the results of recent studies involving a small number of patients:

• 2002 - demonstrated successful recovery of spontaneous circulation with PMS in 46% of patients who had cardiac muscle arrest after cardiac surgery.
• 2011 - published research data, which showed the effectiveness of immediately started direct massage effects in 82% of patients whose circulatory arrest occurred after bypassing the coronary arteries.