A Demonstration of the Role of Potassium and Citrate Ions Under the Conditions of Elective Cardiac Arrest for Open-Heart Operation

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SINCE the preliminary report1 in April 1956, 75 more patients have undergone open-heart operations with elective cardiac arrest according to the Melrose technic2 at the Cleveland Clinic Hospital. Cardiac arrest with potassium citrate permits the surgeon to operate in a quiet, relatively bloodless, open heart.

In this paper no new facts are presented, rather an attempt is made to demonstrate old and well-known truths concerning the effects of certain cations on the myocardium under the conditions of their present clinical application.

Ringer3 was the first to study the effect of electrolytes on the heart muscle; Hering4 arrested ventricular fibrillation in the perfused rabbit’s heart with potassium and saw that the normal beat gradually redeveloped as soon as the perfusate had washed out the excess potassium. Wiggers5 used potassium arrest as a standard laboratory experiment or demonstration for more than 40 years; undoubtedly others have similarly used it for many years. In 1927, concern about the increased death rate from accidental electrocution prompted simultaneous but independent investigations by Hooker6 and by Wiggers.7 They stopped ventricular fibrillation in intact animals by an electric shock or by intracardiac or intra-arterial infusion of potassium chloride. Calcium chloride was thereafter injected to re-establish the heart beat. Those studies formed the basis for cardiac resuscitation as it is now generally accepted. Montgomery, Prevedel, and Swan8 used potassium chloride to stop ventricular fibrillation in hypothermia.

The conversion of ventricular fibrillation by injection of potassium salts is justified by the desperation of the situation. However, the premeditated . . .



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