Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Part I Introduction
- Part II Basic science
- Part III The pathophysiology of global ischemia and reperfusion
- Part IV Therapy of sudden death
- 23 Prevention of sudden cardiac death
- 24 Sequence of therapies during resuscitation: application of CPR
- 25 Transthoracic defibrillation
- 26 Automated external defibrillators
- 27 Public access defibrillation
- 28 The physiology of ventilation during cardiac arrest and other low blood flow states
- 29 Airway techniques and airway devices
- 30 Manual cardiopulmonary resuscitation techniques
- 31 Mechanical devices for cardiopulmonary resuscitation
- 32 Invasive reperfusion techniques
- 33 Routes of drug administration
- 34 Adrenergic agonists
- 35 Vasopressin and other non-adrenergic vasopressors
- 36 Antiarrhythmic therapy during cardiac arrest and resuscitation
- 37 Acid–base considerations and buffer therapy
- 38 Cardiac arrest resuscitation monitoring
- 39 Special considerations in the therapy of non-fibrillatory cardiac arrest
- 40 Cardiocerebral resuscitation: a new approach to out-of-hospital cardiac arrest
- 41 Thrombolysis during resuscitation from cardiac arrest
- 42 Percutaneous coronary intervention (PCI) after successful reestablishment of spontaneous circulation and during cardiopulmonary resuscitation
- 43 Emergency medical services systems and out-of-hospital cardiac arrest
- 44 In-hospital resuscitation
- 45 Complications of CPR
- 46 Bringing it all together: state-of-the-art therapy for cardiac arrest
- Part V Postresuscitation disease and its care
- Part VI Special resuscitation circumstances
- Part VII Special issues in resuscitation
- Index
32 - Invasive reperfusion techniques
from Part IV - Therapy of sudden death
Published online by Cambridge University Press: 06 January 2010
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Part I Introduction
- Part II Basic science
- Part III The pathophysiology of global ischemia and reperfusion
- Part IV Therapy of sudden death
- 23 Prevention of sudden cardiac death
- 24 Sequence of therapies during resuscitation: application of CPR
- 25 Transthoracic defibrillation
- 26 Automated external defibrillators
- 27 Public access defibrillation
- 28 The physiology of ventilation during cardiac arrest and other low blood flow states
- 29 Airway techniques and airway devices
- 30 Manual cardiopulmonary resuscitation techniques
- 31 Mechanical devices for cardiopulmonary resuscitation
- 32 Invasive reperfusion techniques
- 33 Routes of drug administration
- 34 Adrenergic agonists
- 35 Vasopressin and other non-adrenergic vasopressors
- 36 Antiarrhythmic therapy during cardiac arrest and resuscitation
- 37 Acid–base considerations and buffer therapy
- 38 Cardiac arrest resuscitation monitoring
- 39 Special considerations in the therapy of non-fibrillatory cardiac arrest
- 40 Cardiocerebral resuscitation: a new approach to out-of-hospital cardiac arrest
- 41 Thrombolysis during resuscitation from cardiac arrest
- 42 Percutaneous coronary intervention (PCI) after successful reestablishment of spontaneous circulation and during cardiopulmonary resuscitation
- 43 Emergency medical services systems and out-of-hospital cardiac arrest
- 44 In-hospital resuscitation
- 45 Complications of CPR
- 46 Bringing it all together: state-of-the-art therapy for cardiac arrest
- Part V Postresuscitation disease and its care
- Part VI Special resuscitation circumstances
- Part VII Special issues in resuscitation
- Index
Summary
Standard external cardiopulmonary resuscitation (CPR) generates at best, 20% to 25% of normal cardiac output and is frequently inadequate to restore initial cardiac activity. Furthermore, this limited blood flow during CPR decreases as either the time of arrest is prolonged or the time of CPR is increased. When sudden death is the result of ventricular fibrillation, immediate countershock is very effective not only in defibrillating the heart but also in restoring effective myocardial contractions. As the time in which the heart fibrillates in a non-perfused state increases, however, the likelihood of successful defibrillation with restoration of adequate contractile function diminishes. At some point, the heart reaches an irreversible resuscitation state. It is this limited reperfusion capability of standard CPR techniques that continues to drive the search for newer reperfusion techniques following cardiac arrest.
Cardiopulmonary bypass in animal models
Cardiopulmonary bypass has been investigated as a means to reperfuse the non-working heart in cardiac arrest. Cardiopulmonary bypass can generate much higher flows than traditional external chest compression, allowing for resuscitation after prolonged cardiac arrest. Even with the capability of restoring full flow, there are still limits to myocardial resuscitability after long periods of cardiac arrest. In the canine model, normal levels of reperfusion flow generated by cardiopulmonary bypass after 15 and 20 minutes of untreated ventricular fibrillation resulted in successful resuscitation in all animals. After 30 minutes of non-perfused ventricular fibrillation, however, full flow cardiopulmonary bypass was successful in restoring ROSC in only 50% of animals.
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- Chapter
- Information
- Cardiac ArrestThe Science and Practice of Resuscitation Medicine, pp. 600 - 613Publisher: Cambridge University PressPrint publication year: 2007