Causes of Death After External Cardiac Massage: Analysis of Observations on Fifty Consecutive Autopsies

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EXTERNAL cardiac massage for the treatment of catastrophic cessation of heart action has been readily accepted as a means of sustaining peripheral circulation until adequate myocardial function can be restored. This technic has been recently described by Kouwenhoven, Jude, and Knickerbocker.1 However, we are becoming fully aware that the inherent complications of this procedure may be a direct cause of death. A review of these complications has been reported by Baringer, Salzman, Jones, and Friedlich.2 Any morphologic alterations can best be evaluated by thorough study both of the gross and of the microscopic changes present at autopsy. We have reviewed the observations on 50 consecutive autopsies of patients who died after external cardiac massage, have analyzed the conditions possibly precipitating cardiac arrest, and have studied the anatomic changes that developed as a result of external cardiac massage. The 50 patients, on medical or surgical services, received external cardiac massage in the Cleveland Clinic Hospital between May 1961, and March 1962. During this interval there were 14,527 admissions to the Cleveland Clinic Hospital.

Material and Method

The series of 50 patients included 37 males and 13 females whose ages ranged from two and one-half months to 75 years; 11 patients were less than 50 years of age. In each case the clinical chart was analyzed to determine whether or not significant antecedent chronic disease had been present, such as arteriosclerotic heart disease, old or recent myocardial infarctions, congenital heart disease, and pulmonary disorders. It was adjudged beyond the scope of this . . .



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