ABSTRACT
BACKGROUND: Effective cardiopulmonary resuscitation (CPR) should provide acceptable hemodynamics for the vital organs during cardiac arrest and early restoration of spontaneous circulation that guarantees long-term, neurologically intact survival. CPR using heart-lung bypass has been suggested as an option for that use. This study was designed to determine the effectiveness of standard CPR techniques, closed-vs. open-chest CPR, which could be used in the future study verifying the role of heart-lung bypass CPR. MATERIAL AND METHOD: By using adult mongrel dogs, closed-chest CPR (CCCPR, n=4) and open-chest CPR (OCCPR, n=5) were compared with respects to hemodynamics, restoration of spontaneous circulation (ROSC), and survival. Ventricular fibrillation-cardiac arrest (VF-CA) was induced by electrical shock in all animals. After 4 minutes of cardiac arrest, basic life support (BLS) was applied for 15 minutes and followed by advanced life support (ALS). ALS was maintained until achi ving ROSC but not longer than 30 minutes regardless of the recovery. Resuscitation procedures in either group were standardized by adopting the protocol of American Heart Association. RESULT: Prearrest baseline hemodynamic data was not different between two groups. During resuscitation, substantially higher systolic pressure was maintained in OCCPR group than in CCCPR group (45+/-15 vs. 33+/-11 mmHg during BLS, 83+/-36 vs. 44+/-15 mmHg during ALS; p=NS). Mean pulmonary arterial pressure went up to the level of mean systemic arterial pressures in CCCPR group and to half of that in OCCPR group, and had kept higher in CCCPR group throughout CPR (32+/-10 vs. 22+/-4 mmHg during BLS and 32+/-15 vs. 24+/-10 mmHg during ALS; p=NS). ROSC was obtained in 4 of 5 dogs receiving open-chest CPR and 2 of 4 closed-chest CPR. Prolonged survival was noted in all dogs in OCCPR group (6 to 1440 hours) but not in CCPR group (p<.05). CONCLUSION: These findings indicate that open-chest CPR can be more effective t maintain hemodynamics during cardiac arrest and to obtain restoration of spontaneous circulation and survival. Further experiment will be designed to compare heart-lung bypass CPR with open-chest CPR.
Subject(s)
Adult , Animals , Dogs , Humans , American Heart Association , Arterial Pressure , Blood Pressure , Cardiopulmonary Bypass , Cardiopulmonary Resuscitation , Heart Arrest , Hemodynamics , Resuscitation , Shock , Ventricular FibrillationABSTRACT
Tracheoinnominate artery fistula is a rare complication that can happen after tracheostomy, the mortality rate is high and it reqiures urgent surgical management. The patient had received a left pneumonectomy 30 years ago and post-operative course was in uneventful. And tracheostomy was performed for acute respiratory failure due to trachea stenosis for 2 months in recent. She was improved in general condition and changed to a 11 mm silicone Montgomery T-tube. On the 3rd day after the tube changed, she had cardiac arrest due to the excessive hemorrhaging due to tracheoinnominate artery fistula. We report an successusful experience for control of bleeding by an innominate artery fistula division and the Utley maneuver for the tracheoinnominate artery fistula. We report the operation method of bleeding control.
Subject(s)
Humans , Arteries , Brachiocephalic Trunk , Constriction, Pathologic , Fistula , Heart Arrest , Hemorrhage , Mortality , Pneumonectomy , Respiratory Insufficiency , Silicones , Trachea , TracheostomyABSTRACT
Tracheal stenosis is a difficult disease entity to manage. Laser ablation is one effective treatment for treacheal stenosis and can be utilized if tracheal reconstructive surgery is impossible. Potassium titanyl phosphate laser, transmitted via flexible quartz fiber, can be precisely manipulated through flexible bronchoscope under local anesthesia. We treated 7 patients with tracheal and broncheal lesion under local anesthesia with KTP laser from January 1995 to July 1996. The patients included three males and four females. The age of patients ranged from 22 to 66 years with a mean of 43.7 years. The etiology of tracheal stenosis in patients was stenosis after tracheostomy(3 cases), prolong inturbation in cases of sepsis(1 cases), and the recurrence of lung cancer within endobronchial lesion(2 cases). In the cases of tracheal stenosis treated with laser ablation, there were 2 cases of recurrence of stenosis at the anastomosis site after the operation, 3 cases of stenosis at tracheostomy site, and 2 cases of local recurrence of lung cancer. The site of the tracheal stenosis was the balloon site of the tracheostomy tube(3-4cm inferior to the tracheostomy site, 2-3cm superior to the carina) and the anastomosis site that were narrowed to less than 5mm(4 cases). For the stenosis lesion in the endobronchial area, there were 2 patients with a lesion at the anterior wall, 1 patient with a lesion at the posterior wall, 2 patients with circumferential stenosis. Laser ablation time was 25.4+/-5.9min and used energy was 1768+/-365J. We have used KTP laser via flexible bronchoscope without major complications. Adjuvant radiation therapy may prevent fibroblast proliferation which leads to restenosis. In three patients of restenosis after laser ablation, adjuvant irradiation started within 4 hours after laser ablation, and the radiation doses were 1500cGy given in five fraction. In patients with adjuvant radiation therapy, stenosis has not recurred.
Subject(s)
Female , Humans , Male , Anesthesia, Local , Bronchoscopes , Constriction, Pathologic , Fibroblasts , Laser Therapy , Lasers, Solid-State , Lung Neoplasms , Potassium , Quartz , Radiotherapy, Adjuvant , Recurrence , Tracheal Stenosis , TracheostomyABSTRACT
Synovial sarcoma is a malignant soft tissue tumor originated from primitive mesenchymal cell. It occurs primarily in the paraarticular regions, such as knee joint, ankle joint. We experienced a case of intrapulmonary synovial sarcoma which was originated from the lung.