External or Closed-Chest Cardiac Massage

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Abstract
CARDIAC ARREST can occur either as ventricular fibrillation or as ventricular standstill. This emergency has been met by opening the chest and directly massaging the heart and also, if immediately available, by the external cardiac pacemaker and defibrillator. More recently, Kouwenhoven and associates1have described a method of intact chest or external cardiac massage. It is based on the fact that anatomically the heart is limited anteriorly by the sternum and posteriorly by the vertebral bodies, and its lateral movement is restricted by the pericardium. Pressure on the sternum compresses the heart between it and the spine, forcing blood out, and relaxation allows the heart to fill. The thoracic cage in an unconscious individual is very mobile and a movement range of 3 to 4 cm. is possible. The patient should preferably be on a rigid support. The heel of one hand is placed on the sternum, just

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