External Electric Countershock Research Articles

Cardiac Arrest After Mesenteric Manipulation in a Patient Undergoing Abdominal Surgery

Cardiac Arrest After Mesenteric Manipulation in a Patient Undergoing Abdominal Surgery

Insuffisance surrénalienne aiguë postopératoire

Acute adrenal insufficiency is an uncommon complication of lung cancer and adrenal metastasis resection. Diagnosis is difficult to establish but an early recognition and treatment may be life-saving. A 55-year-old man underwent right upper lobectomy and adrenalectomy for lung carcinoma with right adrenal metastasis. Anaesthesia was obtained with propofol, alfentanil, atracurium and isoflurane. Blood pressure remained stable throughout surgical procedure and blood loss was about 3 000 ml. Several hours after the end of the procedure which was uneventful the circulator status worsened. The blood pressure was initially controlled with 500 ml of gelatin. External blood loss was about 200 ml. Clinical examination, chest X-ray and ECG were normal. Postoperative laboratory data showed a serum sodium at 134 mmol −1 · l −1 and a serum potassium 5.1 mmol · l −1 ; haemoglobin concentration was 93 g · l −1. Arterial blood gas analysis, with a 5 l · min −1 nasal o 2 flow showed a Pa o 2 at 108 mmHg, a Pa co 2 at 30 mmHg and a pH at 7.44. Twelve hours later, a transient cardiac arrest occurred which responded to fluid load, dopamine and dobutamine. Six hours later, the patient went in ventricular fibrillation respanding to an external electric countershock. No change in clinical status was noticed, except hyperthermia at 39.5°C. Serum potassium concentration before cardiac arrest was 4.7 mmol · l −1. Main considered diagnoses were septic shock and acute adrenal insufficiency. Antibiotics (imipenem, amikacin and vancomycin) and hormonal treatment (hydrocortisone 200 mg · day −1), after blood samples had been obtained for bacteriological and hormonal examinations. The patient's condition improved dramatically within 48 hours. Shock was under control, dopamine and dobutamine were rapidly discontinued. Stimulation of the adrenals with synthetic corticotrophin tetracosactide (Synacthene® 250 μg) demonstrated failure of the serum cortisol to rise. The cortisol concentrations were very low before and after stimulation (1.4 μg · 100 ml −1 before stimulation and 0.1 μg · 100 ml −1 thereafter). These data as well as negative bacteriological data substantiate the diagnosis of acute adrenal insufficiency. A computer tomography showed an enlargement and inhomogeneous mixed-density of the remaining adrenal which was normal preoperatively. A CT-guided needle biopsy obtained necrotical and haemorrhagic tissue but no tumoral cells. It was concluded that adrenal insufficiency was due to necrosis of the remaining gland. Adrenal necrosis and haemorrhage has been described after sepsis, major trauma, chronic illness, severe surgical stress and systemic anticoagulant therapy. It is a well known but uncommon complication of metastatic carcinoma. In this case, neither heparin was administered nor sepsis occurred and it is speculated that this adrenal gland could have been metastatic with a special susceptibility to necrosis. Initialtime course was satisfying and the patient was discharged to medical unit ten days after surgery. However three days later, a vascular cerebral haemorrhage resulted in death.

Cough-facilitated conversion of ventricular tachycardia

Coughing has been shown to be helpful in altering the bradycardia and hypotension that may occur after intracoronary injections of contrast medium and can enable a patient to maintain consciousness during episodes of ventricular fibrillation and asystole. This report describes a patient with ischemic heart disease in whom 33 episodes of drug-refractory ventricular tachycardia were converted to normal sinus rhythm after abrupt forceful coughs were performed on command. When the patient was unable to cough as directed, external electric countershock was necessary to terminate the arrhythmia. These findings suggest that the cough may in isolated cases be effective in the conversion of potentially fatal ventricular tachyarrhythmias.

Paroxysmal ventricular tachycardia in childhood: Report of a case and review of the literature

Ventricular tachycardia is exceptionally rare in children. A review of the English language literature from 1943 to the present time reveals only 17 cases. It is a serious disturbance of heart rhythm with a grave prognosis in the majority of cases. Quinidine and procaine amide are the drugs of choice in treatment of this arrhythmia. However, external electric countershock was recently used to terminate a sustained attack in an infant. An example of paroxysmal ventricular tachycardia occurring in a 61/2-year-old boy and associated with an upper respiratory infection is presented. There was no evident heart disease.

Successful use of external electrical cardioversion in the treatment of ventricular fibrillation caused by quinidine ∗

Ventricular fibrillation occurring during an attempt at reverting atrial fibrillation with quinidine therapy was successfully treated with external electric countershock. This treatment was also successful in reverting the atrial fibrillation to a normal sinus mechanism.

Ventricular Tachycardia of Thirty-Five Days Duration. A Report of a Case Reverted by Direct Current External Electric Countershock

Ventricular Tachycardia of Thirty-Five Days Duration. A Report of a Case Reverted by Direct Current External Electric Countershock

VENTRICULAR TACHYCARDIA OF THIRTY-FIVE DAYS' DURATION. REPORT OF A CASE REVERTED BY DIRECT CURRENT EXTERNAL ELECTRIC COUNTERSHOCK.

Excerpt Prolonged refractory attacks of ventricular tachycardia are unusual. Survival for significant intervals after such attacks is rare. Most reported cases of ventricular tachycardia do not off...

Termination of Supraventricular Tachycardia Complicating the Wolff-Parkinson-White Syndrome with External Countershock

A case that demonstrates the feasibility of using external electric countershock for termination of paroxysmal supraventricular tachycardia complicating the Wolff-Parkin-son-White syndrome is presented. The occurrence of fusion complexes between impulses originating in the sinoatrial and atrioventricular nodes was observed.

Critical evaluation of indications for external electric countershock in the treatment of ventricular tachycardia

External electric countershock has been recently employed and recommended for the treatment of ventricular tachycardia and other serious arrhythmias, when drug therapy is ineffective and the patient's condition desperate or intolerable. Two cases of ventricular tachycardia are reported in which the use of external countershock was regarded as indicated. In one case, in which other drugs had failed and procaine amide was regarded as contraindicated because of periods of heart block, external countershock was considered urgently necessary because of a deteriorating clinical state. Nevertheless, the tachycardia disappeared spontaneously after withholding all drugs while the patient was carefully observed. In the second case in which drug therapy was considered ineffective after 5 gm. of procaine amide intravenously had caused a widening of the QRS to 0.18 second without conversion, a subsequent, much more rapid infusion of the same drug in a total dose of 1 gm. restored sinus rhythm. An analysis of the cases reported in the literature in which details are presented indicates that procaine amide had been given too slowly or too briefly to regard the drug as ineffective and the urgent need for electric countershock appears questionable. In view of the drastic nature of external electric countershock in the conscious patient and the need for an anesthetic, the requirement of this procedure many different times in some patients, the occurrence of ventricular fibrillation or standstill after counter-shock with the need for further defibrillation or external stimulation, the prompt recurrence of the ventricular tachycardia in some cases, and because of possible fatalities, the indications for such procedure must be most critically assayed in the light of our experience in the two reported cases.

Ventricular tachycardia treated with external electric countershock.

ABSTRACT VENTRICULAR TACHYCARDIA is usually adequately controlled by various medications—procainamide hydrochloride and quinidine being the most effective. Recently external electric countershock has been recommended for patients failing to respond to drugs.1 This is a report of a man with a recent myocardial infarction who developed refractory ventricular tachycardia which was treated by external electric countershock.Report of a Case A 73-yr-old male had an acute posterior myocardial infarction in November, 1960. After an uncomplicated hospital course he was discharged on 5 mg of warfarin sodium daily. He remained well until May 25, 1962, at which time he suddenly developed dull, nonradiating lower anterior chest pain and upper abdominal pain of increasing severity. On May 28, 1962, because of pain and tachycardia, he was hospitalized. An electrocardiogram showed changes suggestive of ventricular tachycardia. The prothrombin content was 12% (38 sec with control of 14 sec); blood urea nitrogen was 21 mg%;

Further application of electric countershock in ventricular tachycardia.

THE EFFICACY of external electric countershock in the termination of ventricular tachycardia has been confirmed. These reports are concerned with medical patients in whom the arrhythmia varied in duration from 9 hours to 22 days, and circulatory collapse, congestive failure, and resistance to drug therapy called for more immediately effective measures. Our experience deals with a surgical patient whose arrhythmia occurred during the induction of anesthesia. Although shock was a prominent feature, congestive failure was not evident. The arrhythmia was of 2 hours' duration, and drug therapy had produced signs of toxicity. Since the patient was in the operating room and anesthetized, electric countershock could be applied without further preparation. Report of a Case A 62-year-old man was admitted to the hospital for reconstructive surgery of a hip. The history revealed 2 attacks of myocardial infarction, 9 and 6 years previously. When examined 3 weeks before admission, the patient was

External electrical termination of supraventricular arrhythmias in congenital heart disease

Persistent supraventricular arrhythmias of the flutter or fibrillation-flutter type have been terminated by elective external electric countershock in three patients after drug therapy had been unsuccessful. It is suggested that this technic is a relatively safe and effective treatment for supraventricular as well as ventricular arrhythmias when anti-arrhythmic drugs have proved ineffective.

Ventricular fibrillation successfully treated by external electric countershock

A 73 year old man with ventricular fibrillation was successfully treated with external electric countershock. The feasibility of effective external cardiac massage followed by defibrillation through the external application of electric countershock is illustrated.

Termination of Refractory Tachycardia by External Countershock

External electric countershock has been used to terminate refractory supraventricular and ventricular tachycardia and atrial fibrillation in eight patients. General anesthesia is necessary when the patient is conscious. This technic is indicated when the patient's condition is desperate or intolerable and drug therapy is ineffective, too slow, or otherwise inadvisable.

External Electrical Termination of Supraventricular Arrhythmias in Congenital Heart Disease

Persistent supraventricular arrhythmias of the flutter or fibrillation-flutter type have been terminated by elective external electric countershock in three patients after drug therapy had been unsuccessful. It is suggested that this technic is a relatively safe and effective treatment for supraventricular as well as ventricular arrhythmias when anti-arrhythmic drugs have proved ineffective.

Use of external electric countershock in the treatment of ventricular tachycardia.

ELECTRIC countershock applied to the closed chest has been successfully used to terminate ventricular fibrillation and prefibrillatory ventricular tachycardia. 1-3 Generally, this technique has been employed as an emergency measure in the unconscious patient with Adams-Stokes disease in the absence of other therapeutic alternatives. No reports exist on the deliberate use of external countershock as an elective procedure to control episodes of ventricular tachycardia in the conscious patient. The following experiences illustrate its effectiveness in the treatment of ventricular tachycardia resistant to drug therapy. Report of a Case A 59-year-old man entered the Peter Bent Brigham Hospital Dec. 1, 1960, with the chief complaint of palpitations, shortness of breath, and profuse sweating of 24-hours duration. In 1949 he sustained an acute myocardial infarction. Six years later he first noted the onset of paroxysmal rapid heart action. In September, 1960, the attacks increased in frequency, often lasting many hours, and

Intravenous drug therapy of Stokes-Adams disease; effects of sympathomimetic amines on ventricular rhythmicity and atrioventricular conduction.

In the treatment of Stokes-Adams disease emergency resuscitation from cardiac arrest can be effected by external electric stimulation or countershock. For the acute problems of persistent ventricular standstill and frequently recurrent seizures, which often appear immediately after resuscitation, intrinsic ventricular pacemakers must be aroused, accelerated, and maintained. In the treatment of these problems the effects of drugs on ventricular rhythmicity and atrioventricular conduction were evaluated. We have found the slow intravenous administration of dilute solutions of sympathomimetic amines to be an effective and safe technic. Epinephrine and isoproterenol were the most useful agents and were comparable in efficacy and toxicity.