抄録
During three years from 1962, the members of thirteen National Hospitals have been studied on the problems of cardiac arrest. The series of study was organized with the members of The First Tokyo-, The Second Tokyo-, Sendai-, Okura-, Sagamihara-, Nagoya-, Maizuru-, Kyoto-, Osaka-, Himeji-, Kure-, and Omura National Hospital.
1) The incident factor of cardiac arrest.
The cardiac arrest was classif icated to both groups of fibrillation and standstill type by the member of Iwakuni Hospital, and they were pointed out the incident factors to both groups by using dogs. Fibrillation can be easily caused by giving Fluothane anesthesia, Atropine, Epinephrine and Succinyl Cholin Chloride, or with blood loss. To standstill there are Ether anesthesia, Chlorpromazine and Prostigmine, or hypoxia, hypercapnea, hyperkalemia and hypercalcemia etc.
In Maizuru Hospital, the effects of electric stimulation or drugs upon the action current of neck vagal nerve of rabbit were observed. And it was confirmed that the cardiac arrest occured at the time of chest operation or by pulling viscero organs is caused by the vago-vagal reflex.
2) Emergency treatment of cardiac arrest.
The problem of external cardiac massage was reexamined at Kyoto Hospital. In this report It was suggested that the heart beat could be recovered well by external cardiac massage only by means of increase of cardiac output or blood pressure. Under this circumstances the effect of external massage was promoted by giving the elevation of extremities or administration of intra-cardiac epinephrine. Furthermore we experienced that an acute cardiac failure and cardiac fibrillation at the time of surgery could be adjusted well by this procedure.
3) About model of def ibrillater.
Defibrillater of alternating current was demonstrated by the member of The Second Tokyo Hospital. The fibrillation could be completely defibrillated with applying 480 volt from the electrode which was set on the chest wall.
In The First Tokyo Hospital the high voltage defibrillater of direct current was demonstrated. This apparatus was shown more evidently effective to defibrillate and also givena less burn to the cardiac wall with this current.
4) The treatment of cardiac arrest at electroconvulsive therapy.
To protect of sudden cardiac arrest at electroconvulsive therapy, the function of treated heart with this procedure had been widely discussed in The First Tokyo Hospital. From this result we could know the protection of its accident by following anesthetic managements.
Administration of atropine (0.5-1.0mg) I. V., 10 to 20 minutes prior to ECT and rather large dosage of pentothal were effective to reduce the grade of arrythmia and fluctuation of blood pressure. Anesthesia was maintained with N2O and O2 with muscle relaxation by S. C. C. Good ventilation and careful management of respiration during and after ECT isnecessary to protect the patient from severe complications.
5) The studies of cardiac arrest during open heart surgery under hypothermia (Osaka Hospital).
The studies on the protection of cardiac arrest which occured in open heart surgery under hypothermia have been carried out by using dogs. In this report it was suggested that the procedure of hypothermia must have gradual cool down, and the grade of anesthesia must have getting deep by ether.
6) The statistic aspects on clinical cases.
During the past three years from 1962, the incidence of cardiac arrest in surgical cases was 28 in thirteen national hospitals. The incident proportion to total operated cases was shown as 1: 2, 670. Eleven in 23 cases were survivals. Four cases of sinus tachycardia and extrasystole on ECG as poor risk detected before operation were all dead. The main factors presumed as direct cause to cardiac arrest were pointed out the factors of excess bleeding, vago-vagal reflex and anoxia.
