Successful prolonged resuscitation after open heart surgery.

Five selected cases of successful prolonged resuscitation (up to 16 hours) after open heart surgery are presented. Four had undergone prosthetic valve insertion, two being double replacements. External cardiac massage did not produce any demonstrable damage to the heart or the implanted valve prostheses, the competent prostheses probably assuring the haemodynamic effectiveness of the massage. Intermittent positive pressure breathing via an endotracheal tube providing 100% oxygen was begun immediately in all cases. The continuous monitoring of blood pressure through an intra-arterial cannula during resuscitation was of great value. It indicated the minimum amount of force that had to be applied to obtain satisfactory perfusion and enabled frequent arterial blood sampling for pH and blood gas analyses. Thus acidosis could rapidly and effectively be corrected. Comment is made upon the use of bretylium tosylate and chlorpromazine during resuscitation. The value of the continuous presence of a physician at the bedside of patients after open heart surgery and an aggressive, stubborn approach to cardiopulmonary resuscitation as long as vital signs are present is stressed.