抄録
The present paper deals with the studies on cardiac arrest, cardiac resuscitation and some experimental studies. We have experienced 17 cases (male: 9 female: 8) of cardiac arrest during the past four and a half years at the Surgical Clinic, 2nd Tokyo National Hospital. The youngest case was one year and 6 months old and the oldest, 71 years of old. Most of the cases was in the ages of 31 to 60, Eight cases were treated at the surgical clinic, 3 at the dermato-urological clinic, 2 at internal medical clinic, 1 each at Gynecological Clinic, Oto-radnological clinic, TB clinic and radiological clinic, respectively. The incidence to the number of operations was 0.057%. The essential cause of the occurrence was hypoxia.
By place of the occurrence, 9 cases in the Operating Room, 4 in wards, 3 at Ambulatory Board and 1 in X-ray Room.
By time of occurrence, 7 cases were midst of operation, 2 during anesthesia, 2 at postoperative procedures, 3 during treatments in the ward, 2 at ambulance, and 1 during x-ray investigation.
Occurrences by the sites of operation were as follows: 0, 23% of neck: 0.13% of breast (0.52% of thoracotomy): 0.11% of abdomen and 0.01% of the other sites.
Occurrences by the types of anesthesia were as follows 0.12% of general; 0.04% of spinal, 0.03% of local anesthesia, and 0.061% in the total.
As for the types of cardiac arrest, 13 cases were cardiac standstill, I ventricular fibrillation and 3 cases had transient form of the former to the latter.
By the result of treatments, 2 cases survived, and 15 cases were unsuccessfull treated. Treatment within 3-4 minutes after the onset of cardiac arrest seemed to be essential for success. In all the fatal cases, temporary recovery of heart beats was obtained.
II Experimental Study
Thirteen medium-sized mongrel dogs were given thoracotomy under general anesthesia (with intratracheal intubation), pericardiotomy, the ventricular fibrillation by electric-shock, and defibrillation by counter-shock and cardial massage, then heart-beats was restored. Then the heart was examined from just after to 2 months and a half after the experiments.
Common early changes just after the experiment were subepicardial and intramyocardial capillary bleeding. Veins became congestive, arteries remained vacant and coronary insufficiency was obvious. But these changes were slight in the cases of cardiac massage or fibrillation alone, and any remarkable morphological change of muscle fibrins was not observed.
In the cases pf massage and counter-shock for 5 to 90 minutes, the above mentioned changes of blood-vessels were obvious but no abnormality in the muscle fibers except infrequent slight separation, fragmentation and a slight degenerative changes of muscle fibers. But judging from ECG, these changes were considered reversible. These changes were notinfluenced remarkably by prolonged massage.
In the cases of too vigorous massage and frequent counter-shock, we found intense bleeding and acute necrosis in myocardium.
From a week to 2 months and a half after the experiments, only fibrosis of stroma and slight pericarditis were seen and myocarditis disappeared, and bleeding and cell infiltration already disappeared.
Electric damage by counter-shock was not observed.
Electron microscopically, swollen-up appearance of mitochondriae, accompanied by deformation and destruction of cristae, loosening of myofibrines by increase of sarcoplasmae and dilation of perinuclear zone were observed but these changes were reversible and returned to nearly normal state.
Conclusively, though cardiac massage and counter shock causes temporary and reversible changes, there is no special damages or failure of cardiac function. However, in cases of serious myocardial and vascular lesions, too vigorous massage will bring about unrecovered damages or even myocardial rupture.
Cardiac arrest could be occurred at any time, any place, any sex and age, in mostly surgical procedu
