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Sun Jun 11 07:11:33 BST 2006

Dr Benson,

The work was also done in babboons in the 70's as I noted.  People still push for closed chest CPR as perhaps it is easier, perhaps they are afraid of blood, ???

If it worked, one would wonder why the Red Cross changes the technique of closed chest CPR every year or so.  Why the in-hospital success rate of CPR is not better.   You are correct.  The physiology of closed chest CPR demonstrates that it will always be unsuccessful.

Again, one should read the article out last year with the highest number of open-chest resuscitations that I have seen.  Like Babe Ruth, highest strike-outs, but also highest home runs.

Dr. Chan.  I do not know how many open chest CPRs are done for cardiac.  I do know that the beloved Mayor of Chicago had it done on him at Northwestern  about 20 years ago (he was dead to start with).  I also believe that most of us would want it done to ourselves if we were long minutes from cardioversion - or to have nothing done but put our heads in ice AND NOT CLOSED chest cpr.

j

________________________________

From: trauma-list-bounces at trauma.org on behalf of bensonblues at comcast.net
Sent: Sat 6/10/2006 12:41 AM
To: trauma-list at trauma.org
Subject: Open Chest CPR

John R,

This is my final contribution to the topic. I believe that I would have gotten the same results whether the subjects were healthy dogs, lions, llamas, or linesmen. I feel that the best chance for neurologic survival in any scenario is OC-CPR. It was gut-renching research (I love dogs), and I am probably retired from the laboratory because of my experience.

Benson DM, O'Neil BO, Kakish E, Erpelding J, et al: Open chest CPR improves survival and neurologic outcome following cardiac arrest. RESUSCITATION 2005; 64:209-217.

Abstract
Study Objective: To determine if 15 minutes of open-chest cardiac massage (OC-CPR)
vs. closed-chest compressions (CC-CPR) improves 72-hour survival and neurologic outcome (behavioral and histologic) after 5 minutes of untreated cardiac arrest.

Methods: Mongrel dogs were anesthetized and instrumented.  Cardiac arrest was induced by KCl injection and after a 5-minute period of non-intervention, dogs were randomized to receive either CC-CPR (N = 7) or OC-CPR (N = 5) performed for 15 minutes. The dogs were then resuscitated and physiologic data was recorded. Surviving dogs were scored at 72 hours using Safar's canine NDS (NDS, 0 = behaviorally normal, 500 = brain death). Dogs that could not be resuscitated or died before 72 hours were assigned a score of 500.  Brain histology was performed on all survivors. 

Results: All OC-CPR dogs were successfully resuscitated and were behaviorally normal at 72 hours (NDS = 0).  Histology in OC-CPR dogs showed little to no injury.  Only 3/7 CC-CPR dogs survived to 72 hours.  Of the survivors, 1 dog exhibited minor ataxia (NDS = 15), and two had incapacitating deficits (both NDS = 180). Two dogs died within 24 hours after extubation, and one could not be resuscitated and the other could not be weaned from the ventilator, (each NDS = 500). Histology of the CC-CPR survivors revealed moderate to severe lesions. NDS between groups was statistically significant (p < 0.0079).

Conclusion: In our canine model of cardiac arrest, OC-CPR significantly improved 72 hour survival and neurologic outcome when compared CC-CPR.

DB
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