Starzl, Thomas E

English

PubMed

Starzl, TE

Name not available

The role of electrical pacemakers in the treatment of unexpected cardiac arrest

D-Scholarship@Pitt

THE ROLE OF ELECTRICAL PACEMAKERS IN THE TREATMENT OF UNEXPECTED CARDIAC ARREST TIIOMAS E. STARZL, M.D., Chicago, Illinois DURING THE PAST 8 YEARS cardiac pacemak- ers have found an important use in the immediate and prolonged treatment of post- operative or spontaneously occurring heart block in which the idioventricular rate has become too slow to provide adequate car- diac output. Scarcely a major hospital in the country lacks one of these electronic devices. For the treatment of Stokes-Adams disease with heart block the role of pace- maker therapy is well established, but in other situations the popularity of pace- makers has sometimes outstripped their value. Ill-conceived efforts at cardiac stimu- lation can result in deaths either by direct injury or because the effort at pacemaking supplants more effective means of therapy. The commonest of these abuses have oc- curred in the treatment of patients with cardiac arrest. Some patients with cardiac arrest have been resuscitated with pacemaker therapy. This group of patients should serve as a guide in determining the limitations and indications for electrical stimulation in car- diac arrest. In virtually all successful cases the possibility of cardiac arrest was recog- nized in advance, either because of pre- existing abnormalities such as heart block or because of capricious behavior of the heart under anesthesia. Because of the advance warning, the pacemaker was available at  the patient's side and often the electrodes were in position on the chest. When arrest oc- curred, stimulation was immediately per- formed. Pacemaking warranted a trial un- der these circumstances both because this is l<c.f,rint,fro~n SURGERY, Gynecology & Obstetrics, May, Copyright, 1961, L>- The Frarlhlirl H. Martin Merl~orial Foundation the time when stimulation is most apt to succeed and because its use if unsuccessful would not materially delay the institution of some form of cardiac massage. If pacemaker therapy cannot be imme- diately applied, it is likely to fail even in thc most favorable cases. The capacity for elec- trically evoked contraction decreases with every second of continued asystole so that in 2 or 3 minutes an unresponsive myocar- dium develops in a favorable candidate for stimulation. In other cases, the assumption that cardiac arrest is due purely to failure of the conduction system may not be war- ranted. Almost invariably the arrest is the final result of a bout of anoxia and hyper- capnia in which the myocardium has also been damaged. In other instances, fibrilla- tion may have occurred, or a heart beat may be present but so feeble that no blood pressure is obtainable. When cardiac arrest is announced, the patient's chance for prompt massage may be delayed by frantic and time-consuming efforts to procure and apply a pacemaker. When electrical stimu- lation is finally begun in such patients with unexpected arrest, the myocardium will usually be incapable of contraction. The primary emphasis in the therapy of unexpected cardiac arrest should still be on cardiac massage, carried out directly or con- ceivably by the recently described method of external compression. If electrical pace- making is to be tried, it should be under circumstances which will not significantly delay the application of standard methods of treatment. 1 9 6 1 ,  Vol. 112, 6 2 4  P R I N T E D  B Y  R .  R .  D O N N E L L E Y  B S O N S  C O . ,  AT C H I C A G O .  I L L I N O I S ,  U . S . A .  

The Role of Electrical Pacemakers in the Treatment of Unexpected Cardiac Arrest.

http://d-scholarship.pitt.edu/3417/1/31735062123397.pdf

The Role of Electrical Pacemakers in the Treatment of Unexpected Cardiac Arrest.

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