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eComment: External cardiac massage may be harmful as well as unnecessary

Papworth Hospital, Cambridge CB23 3RE, UK

If a patient arrests after cardiac surgery is it acceptable to delay cardiopulmonary resuscitation until you have attempted either defibrillation or pacing?

Lockowandt and coworkers ask a very important question about whetherit is ever acceptable to delay cardiac massage [1]. Cardiac arrest aftercardiac surgery is different from cardiac arrest in a general hospital ward.

When due to ventricular fibrillation, a defibrillator is usually immediatelyavailable and the treatment of choice should be immediate defibrillation.

When due to severe bradycardia or complete heart block or asystole,pacing wires are often in place and if so, pacing is the treatment of choice.

When due to tamponade or catastrophic haemorrhage, external massagemay not help and reopening the chest is the treatment of choice.

When due to tension pneumothorax, external massage may also not helpand drainage is the treatment of choice.

When all this is added to the risk of damage to sternum, heart and suturelines, it makes a compelling case for delaying external massage by a fewseconds if that allows the immediate administration of the treatment ofchoice (such as defibrillation or pacing) as there is every chance that theseinterventions may correct the problem thus avoiding the need for potentiallydamaging massage in the first place.

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1. Lockowandt U, Levine A, Strang T, Dunning J. If a patient arrests after cardiac surgery is it acceptable to delay cardiopulmonary resuscitation until you have attempted either defibrillation or pacing? Interac CardioVasc Thorac Surg 2008;7:878–887.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Samer A.M. Nashef Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nashef, S. A.M. Search for Related Content PubMed PubMed Citation Articles by Nashef, S. A.M. Related Collections Related Article