Failure of Closed Chest Cardiac Massage to Produce Pulmonry Ventilation

Abstract

Rhythmic sternal pressure produced no tidal exchange in 30 curarized adults with a natural airway and the head unsupported, since lack of backward tilt of the head caused hypopharyngeal obstruction by the tongue. Even when the shoulders were elevated, in order to make the head assume a backward tilt, sternal compressions produced no tidal exchange in 16 of 30 subjects. With a tracheal tube by-passing the upper airway obstruction, sternal compression produced an average tidal volume of 156 ml. (0 to 390 ml.). In patients with cardiac arrest closed chest cardiac massage produced no tidal exchange even with the use of a tracheal tube, while intermittent positive pressure ventilation produced tidal volumes of over 1000 ml. Rhythmic sternal compression failed to reoxygenate five of six hypoxic curarized adults. Closed chest cardiac massage should be accompanied by positive pressure ventilation of the lungs. One of several possible combinations consists of following each lung inflation by four sternal compressions, at one second intervals.