Future directions for resuscitation research V: ultra-advanced life support
Identifieur interne : 000177 ( PascalFrancis/Corpus ); précédent : 000176; suivant : 000178Future directions for resuscitation research V: ultra-advanced life support
Auteurs : S. A. Tisherman ; K. Vandevelde ; P. Safar ; T. Morioka ; W. Obrist ; L. Corne ; R. F. Buckman ; S. Rubertsson ; H. E. Stephenson ; A. Grenvik ; R. J. WhiteSource :
- Resuscitation [ 0300-9572 ] ; 1997.
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- Pascal (Inist)
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Abstract
Copyright (c) 1997 Elsevier Science Ireland Ltd. All rights reserved. Standard external cardiopulmonary resuscitation (SECPR) frequently produces very low perfusion pressures, which are inadequate to achieve restoration of spontaneous circulation (ROSC) and intact survival, particularly when the heart is diseased. Ultra-advanced life support (UALS) techniques may allow support of vital organ systems until either the heart recovers or cardiac repair or replacement is performed. Closed-chest emergency cardiopulmonary bypass (CPB) provides control of blood flow, pressure, composition and temperature, but has so far been applied relatively late. This additional low-flow time may preclude conscious survival. An easy, quick method for vessel access and a small preprimed system that could be taken into the field are needed. Open-chest CPR (OCCPR) is physiologically superior to SECPR, but has also been initiated too late in prior studies. Its application in the field has recently proven feasible. Variations of OCCPR, which deserve clinical trials inside and outside hospitals, include 'minimally invasive direct cardiac massage' (MIDCM), using a pocket-size plunger-like device inserted via a small incision and 'direct mechanical ventricular actuation' (DMVA), using a machine that pneumatically drives a cup placed around the heart. Other novel UALS approaches for further research include the use of an aortic balloon catheter to improve coronary and cerebral blood flow during SECPR, aortic flush techniques and a double-balloon aortic catheter that could allow separate perfusion (and cooling) of the heart, brain and viscera for optimal resuscitation of each. Decision-making, initiation of UALS methods and diagnostic evaluations must be rapid to maximize the potential for ROSC and facilitate decision-making regarding long-term circulatory support versus withdrawal of life support for hopeless cases. Research and development of UALS technique needs to be coordinated with cerebral resuscitation research. Copyright © 1997 Elsevier Science Ireland Ltd.
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Format Inist (serveur)
| NO : | PASCAL 97-0447781 Elsevier |
|---|---|
| ET : | Future directions for resuscitation research V: ultra-advanced life support |
| AU : | TISHERMAN (S. A.); VANDEVELDE (K.); SAFAR (P.); MORIOKA (T.); OBRIST (W.); CORNE (L.); BUCKMAN (R. F.); RUBERTSSON (S.); STEPHENSON (H. E.); GRENVIK (A.); WHITE (R. J.) |
| AF : | Safar Center for Resuscitation Research, University of Pittsburgh, 3434 Fifth Avenue/Pittsburgh, PA 15260/Etats-Unis (1 aut., 3 aut.); St. Jans Hospital/Brugge/Belgique (2 aut.); Departments of Anesthesiology and Neurosurgery, University of Pittsburgh/Pittsburgh, PA/Etats-Unis (5 aut., 8 aut., 10 aut.); Kumamoto University School of Medicine/Kumamoto/Japon (4 aut.); University Hospital, Free University of Brussels/Brussels/Belgique (6 aut.); Temple University School of Medicine/Philadelphia, PA/Etats-Unis (7 aut.); No affiliation given/Columbia, MO/Etats-Unis (9 aut.); Metro Health Medical Center/Cleveland, OH/Etats-Unis (11 aut.) |
| DT : | Publication en série; Niveau analytique |
| SO : | Resuscitation; ISSN 0300-9572; Coden RSUSBS; Irlande; Da. 1997; Vol. 34; No. 3; Pp. 281-293; Abs. anglais |
| LA : | Anglais |
| EA : | Copyright (c) 1997 Elsevier Science Ireland Ltd. All rights reserved. Standard external cardiopulmonary resuscitation (SECPR) frequently produces very low perfusion pressures, which are inadequate to achieve restoration of spontaneous circulation (ROSC) and intact survival, particularly when the heart is diseased. Ultra-advanced life support (UALS) techniques may allow support of vital organ systems until either the heart recovers or cardiac repair or replacement is performed. Closed-chest emergency cardiopulmonary bypass (CPB) provides control of blood flow, pressure, composition and temperature, but has so far been applied relatively late. This additional low-flow time may preclude conscious survival. An easy, quick method for vessel access and a small preprimed system that could be taken into the field are needed. Open-chest CPR (OCCPR) is physiologically superior to SECPR, but has also been initiated too late in prior studies. Its application in the field has recently proven feasible. Variations of OCCPR, which deserve clinical trials inside and outside hospitals, include 'minimally invasive direct cardiac massage' (MIDCM), using a pocket-size plunger-like device inserted via a small incision and 'direct mechanical ventricular actuation' (DMVA), using a machine that pneumatically drives a cup placed around the heart. Other novel UALS approaches for further research include the use of an aortic balloon catheter to improve coronary and cerebral blood flow during SECPR, aortic flush techniques and a double-balloon aortic catheter that could allow separate perfusion (and cooling) of the heart, brain and viscera for optimal resuscitation of each. Decision-making, initiation of UALS methods and diagnostic evaluations must be rapid to maximize the potential for ROSC and facilitate decision-making regarding long-term circulatory support versus withdrawal of life support for hopeless cases. Research and development of UALS technique needs to be coordinated with cerebral resuscitation research. Copyright © 1997 Elsevier Science Ireland Ltd. |
| CC : | 002B27B01 |
| FD : | Arrêt cardiocirculatoire; Réanimation cardiocirculatoire; Recherche scientifique; Traitement; Technique; Optimisation; Homme |
| FG : | Appareil circulatoire pathologie |
| ED : | Cardiocirculatory arrest; Intensive cardiocirculatory care; Scientific research; Treatment; Technique; Optimization; Human |
| EG : | Cardiovascular disease |
| GD : | Aufbereiten; Optimierung |
| SD : | Paro cardiocirculatorio; Reanimación cardiocirculatoria; Investigación científica; Tratamiento; Técnica; Optimización; Hombre |
| LO : | INIST-21284.354000061533900018 |
| ID : | 97-0447781 |
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White</name><affiliation><inist:fA14 i1="08"><s1>Metro Health Medical Center</s1><s2>Cleveland, OH</s2><s3>USA</s3><sZ>11 aut.</sZ></inist:fA14></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">97-0447781</idno><date when="1997">1997</date><idno type="stanalyst">PASCAL 97-0447781 Elsevier</idno><idno type="RBID">Pascal:97-0447781</idno><idno type="wicri:Area/PascalFrancis/Corpus">000177</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Future directions for resuscitation research V: ultra-advanced life support</title><author><name sortKey="Tisherman, S A" sort="Tisherman, S A" uniqKey="Tisherman S" first="S. A." last="Tisherman">S. A. Tisherman</name><affiliation><inist:fA14 i1="01"><s1>Safar Center for Resuscitation Research, University of Pittsburgh, 3434 Fifth Avenue</s1><s2>Pittsburgh, PA 15260</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Vandevelde, K" sort="Vandevelde, K" uniqKey="Vandevelde K" first="K." last="Vandevelde">K. Vandevelde</name><affiliation><inist:fA14 i1="02"><s1>St. Jans Hospital</s1><s2>Brugge</s2><s3>BEL</s3><sZ>2 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Safar, P" sort="Safar, P" uniqKey="Safar P" first="P." last="Safar">P. Safar</name><affiliation><inist:fA14 i1="01"><s1>Safar Center for Resuscitation Research, University of Pittsburgh, 3434 Fifth Avenue</s1><s2>Pittsburgh, PA 15260</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Morioka, T" sort="Morioka, T" uniqKey="Morioka T" first="T." last="Morioka">T. Morioka</name><affiliation><inist:fA14 i1="04"><s1>Kumamoto University School of Medicine</s1><s2>Kumamoto</s2><s3>JPN</s3><sZ>4 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Obrist, W" sort="Obrist, W" uniqKey="Obrist W" first="W." last="Obrist">W. Obrist</name><affiliation><inist:fA14 i1="03"><s1>Departments of Anesthesiology and Neurosurgery, University of Pittsburgh</s1><s2>Pittsburgh, PA</s2><s3>USA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Corne, L" sort="Corne, L" uniqKey="Corne L" first="L." last="Corne">L. Corne</name><affiliation><inist:fA14 i1="05"><s1>University Hospital, Free University of Brussels</s1><s2>Brussels</s2><s3>BEL</s3><sZ>6 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Buckman, R F" sort="Buckman, R F" uniqKey="Buckman R" first="R. F." last="Buckman">R. F. Buckman</name><affiliation><inist:fA14 i1="06"><s1>Temple University School of Medicine</s1><s2>Philadelphia, PA</s2><s3>USA</s3><sZ>7 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Rubertsson, S" sort="Rubertsson, S" uniqKey="Rubertsson S" first="S." last="Rubertsson">S. Rubertsson</name><affiliation><inist:fA14 i1="03"><s1>Departments of Anesthesiology and Neurosurgery, University of Pittsburgh</s1><s2>Pittsburgh, PA</s2><s3>USA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Stephenson, H E" sort="Stephenson, H E" uniqKey="Stephenson H" first="H. E." last="Stephenson">H. E. Stephenson</name><affiliation><inist:fA14 i1="07"><s1>No affiliation given</s1><s2>Columbia, MO</s2><s3>USA</s3><sZ>9 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Grenvik, A" sort="Grenvik, A" uniqKey="Grenvik A" first="A." last="Grenvik">A. Grenvik</name><affiliation><inist:fA14 i1="03"><s1>Departments of Anesthesiology and Neurosurgery, University of Pittsburgh</s1><s2>Pittsburgh, PA</s2><s3>USA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="White, R J" sort="White, R J" uniqKey="White R" first="R. J." last="White">R. J. White</name><affiliation><inist:fA14 i1="08"><s1>Metro Health Medical Center</s1><s2>Cleveland, OH</s2><s3>USA</s3><sZ>11 aut.</sZ></inist:fA14></affiliation></author></analytic><series><title level="j" type="main">Resuscitation</title><title level="j" type="abbreviated">Resuscitation</title><idno type="ISSN">0300-9572</idno><imprint><date when="1997">1997</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Resuscitation</title><title level="j" type="abbreviated">Resuscitation</title><idno type="ISSN">0300-9572</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Cardiocirculatory arrest</term><term>Human</term><term>Intensive cardiocirculatory care</term><term>Optimization</term><term>Scientific research</term><term>Technique</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Arrêt cardiocirculatoire</term><term>Réanimation cardiocirculatoire</term><term>Recherche scientifique</term><term>Traitement</term><term>Technique</term><term>Optimisation</term><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Copyright (c) 1997 Elsevier Science Ireland Ltd. All rights reserved. Standard external cardiopulmonary resuscitation (SECPR) frequently produces very low perfusion pressures, which are inadequate to achieve restoration of spontaneous circulation (ROSC) and intact survival, particularly when the heart is diseased. Ultra-advanced life support (UALS) techniques may allow support of vital organ systems until either the heart recovers or cardiac repair or replacement is performed. Closed-chest emergency cardiopulmonary bypass (CPB) provides control of blood flow, pressure, composition and temperature, but has so far been applied relatively late. This additional low-flow time may preclude conscious survival. An easy, quick method for vessel access and a small preprimed system that could be taken into the field are needed. Open-chest CPR (OCCPR) is physiologically superior to SECPR, but has also been initiated too late in prior studies. Its application in the field has recently proven feasible. Variations of OCCPR, which deserve clinical trials inside and outside hospitals, include 'minimally invasive direct cardiac massage' (MIDCM), using a pocket-size plunger-like device inserted via a small incision and 'direct mechanical ventricular actuation' (DMVA), using a machine that pneumatically drives a cup placed around the heart. Other novel UALS approaches for further research include the use of an aortic balloon catheter to improve coronary and cerebral blood flow during SECPR, aortic flush techniques and a double-balloon aortic catheter that could allow separate perfusion (and cooling) of the heart, brain and viscera for optimal resuscitation of each. Decision-making, initiation of UALS methods and diagnostic evaluations must be rapid to maximize the potential for ROSC and facilitate decision-making regarding long-term circulatory support versus withdrawal of life support for hopeless cases. Research and development of UALS technique needs to be coordinated with cerebral resuscitation research. Copyright © 1997 Elsevier Science Ireland Ltd.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0300-9572</s0></fA01><fA02 i1="01"><s0>RSUSBS</s0></fA02><fA03 i2="1"><s0>Resuscitation</s0></fA03><fA05><s2>34</s2></fA05><fA06><s2>3</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Future directions for resuscitation research V: ultra-advanced life support</s1></fA08><fA11 i1="01" i2="1"><s1>TISHERMAN (S. A.)</s1></fA11><fA11 i1="02" i2="1"><s1>VANDEVELDE (K.)</s1></fA11><fA11 i1="03" i2="1"><s1>SAFAR (P.)</s1></fA11><fA11 i1="04" i2="1"><s1>MORIOKA (T.)</s1></fA11><fA11 i1="05" i2="1"><s1>OBRIST (W.)</s1></fA11><fA11 i1="06" i2="1"><s1>CORNE (L.)</s1></fA11><fA11 i1="07" i2="1"><s1>BUCKMAN (R. F.)</s1></fA11><fA11 i1="08" i2="1"><s1>RUBERTSSON (S.)</s1></fA11><fA11 i1="09" i2="1"><s1>STEPHENSON (H. E.)</s1></fA11><fA11 i1="10" i2="1"><s1>GRENVIK (A.)</s1></fA11><fA11 i1="11" i2="1"><s1>WHITE (R. J.)</s1></fA11><fA14 i1="01"><s1>Safar Center for Resuscitation Research, University of Pittsburgh, 3434 Fifth Avenue</s1><s2>Pittsburgh, PA 15260</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ></fA14><fA14 i1="02"><s1>St. Jans Hospital</s1><s2>Brugge</s2><s3>BEL</s3><sZ>2 aut.</sZ></fA14><fA14 i1="03"><s1>Departments of Anesthesiology and Neurosurgery, University of Pittsburgh</s1><s2>Pittsburgh, PA</s2><s3>USA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ></fA14><fA14 i1="04"><s1>Kumamoto University School of Medicine</s1><s2>Kumamoto</s2><s3>JPN</s3><sZ>4 aut.</sZ></fA14><fA14 i1="05"><s1>University Hospital, Free University of Brussels</s1><s2>Brussels</s2><s3>BEL</s3><sZ>6 aut.</sZ></fA14><fA14 i1="06"><s1>Temple University School of Medicine</s1><s2>Philadelphia, PA</s2><s3>USA</s3><sZ>7 aut.</sZ></fA14><fA14 i1="07"><s1>No affiliation given</s1><s2>Columbia, MO</s2><s3>USA</s3><sZ>9 aut.</sZ></fA14><fA14 i1="08"><s1>Metro Health Medical Center</s1><s2>Cleveland, OH</s2><s3>USA</s3><sZ>11 aut.</sZ></fA14><fA20><s1>281-293</s1></fA20><fA21><s1>1997</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA24 i1="01"><s0>eng</s0></fA24><fA43 i1="01"><s1>INIST</s1><s2>21284</s2><s5>354000061533900018</s5></fA43><fA44><s0>9000</s0><s1>© 1997 Elsevier Science B.V. All rights reserved.</s1></fA44><fA47 i1="01" i2="1"><s0>97-0447781</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Resuscitation</s0></fA64><fA66 i1="01"><s0>IRL</s0></fA66><fC01 i1="01" l="ENG"><s0>Copyright (c) 1997 Elsevier Science Ireland Ltd. All rights reserved. Standard external cardiopulmonary resuscitation (SECPR) frequently produces very low perfusion pressures, which are inadequate to achieve restoration of spontaneous circulation (ROSC) and intact survival, particularly when the heart is diseased. Ultra-advanced life support (UALS) techniques may allow support of vital organ systems until either the heart recovers or cardiac repair or replacement is performed. Closed-chest emergency cardiopulmonary bypass (CPB) provides control of blood flow, pressure, composition and temperature, but has so far been applied relatively late. This additional low-flow time may preclude conscious survival. An easy, quick method for vessel access and a small preprimed system that could be taken into the field are needed. Open-chest CPR (OCCPR) is physiologically superior to SECPR, but has also been initiated too late in prior studies. Its application in the field has recently proven feasible. Variations of OCCPR, which deserve clinical trials inside and outside hospitals, include 'minimally invasive direct cardiac massage' (MIDCM), using a pocket-size plunger-like device inserted via a small incision and 'direct mechanical ventricular actuation' (DMVA), using a machine that pneumatically drives a cup placed around the heart. Other novel UALS approaches for further research include the use of an aortic balloon catheter to improve coronary and cerebral blood flow during SECPR, aortic flush techniques and a double-balloon aortic catheter that could allow separate perfusion (and cooling) of the heart, brain and viscera for optimal resuscitation of each. Decision-making, initiation of UALS methods and diagnostic evaluations must be rapid to maximize the potential for ROSC and facilitate decision-making regarding long-term circulatory support versus withdrawal of life support for hopeless cases. Research and development of UALS technique needs to be coordinated with cerebral resuscitation research. Copyright © 1997 Elsevier Science Ireland Ltd.</s0></fC01><fC02 i1="01" i2="X"><s0>002B27B01</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Arrêt cardiocirculatoire</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Cardiocirculatory arrest</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Paro cardiocirculatorio</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Réanimation cardiocirculatoire</s0><s5>04</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Intensive cardiocirculatory care</s0><s5>04</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Reanimación cardiocirculatoria</s0><s5>04</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Recherche scientifique</s0><s5>07</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Scientific research</s0><s5>07</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Investigación científica</s0><s5>07</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Traitement</s0><s5>17</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Treatment</s0><s5>17</s5></fC03><fC03 i1="04" i2="X" l="GER"><s0>Aufbereiten</s0><s5>17</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Tratamiento</s0><s5>17</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Technique</s0><s5>18</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Technique</s0><s5>18</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Técnica</s0><s5>18</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Optimisation</s0><s5>19</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Optimization</s0><s5>19</s5></fC03><fC03 i1="06" i2="X" l="GER"><s0>Optimierung</s0><s5>19</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Optimización</s0><s5>19</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Homme</s0><s5>20</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Human</s0><s5>20</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Hombre</s0><s5>20</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Appareil circulatoire pathologie</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Cardiovascular disease</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Aparato circulatorio patología</s0><s5>37</s5></fC07><fN21><s1>272</s1></fN21></pA></standard><server><NO>PASCAL 97-0447781 Elsevier</NO><ET>Future directions for resuscitation research V: ultra-advanced life support</ET><AU>TISHERMAN (S. A.); VANDEVELDE (K.); SAFAR (P.); MORIOKA (T.); OBRIST (W.); CORNE (L.); BUCKMAN (R. F.); RUBERTSSON (S.); STEPHENSON (H. E.); GRENVIK (A.); WHITE (R. J.)</AU><AF>Safar Center for Resuscitation Research, University of Pittsburgh, 3434 Fifth Avenue/Pittsburgh, PA 15260/Etats-Unis (1 aut., 3 aut.); St. Jans Hospital/Brugge/Belgique (2 aut.); Departments of Anesthesiology and Neurosurgery, University of Pittsburgh/Pittsburgh, PA/Etats-Unis (5 aut., 8 aut., 10 aut.); Kumamoto University School of Medicine/Kumamoto/Japon (4 aut.); University Hospital, Free University of Brussels/Brussels/Belgique (6 aut.); Temple University School of Medicine/Philadelphia, PA/Etats-Unis (7 aut.); No affiliation given/Columbia, MO/Etats-Unis (9 aut.); Metro Health Medical Center/Cleveland, OH/Etats-Unis (11 aut.)</AF><DT>Publication en série; Niveau analytique</DT><SO>Resuscitation; ISSN 0300-9572; Coden RSUSBS; Irlande; Da. 1997; Vol. 34; No. 3; Pp. 281-293; Abs. anglais</SO><LA>Anglais</LA><EA>Copyright (c) 1997 Elsevier Science Ireland Ltd. All rights reserved. Standard external cardiopulmonary resuscitation (SECPR) frequently produces very low perfusion pressures, which are inadequate to achieve restoration of spontaneous circulation (ROSC) and intact survival, particularly when the heart is diseased. Ultra-advanced life support (UALS) techniques may allow support of vital organ systems until either the heart recovers or cardiac repair or replacement is performed. Closed-chest emergency cardiopulmonary bypass (CPB) provides control of blood flow, pressure, composition and temperature, but has so far been applied relatively late. This additional low-flow time may preclude conscious survival. An easy, quick method for vessel access and a small preprimed system that could be taken into the field are needed. Open-chest CPR (OCCPR) is physiologically superior to SECPR, but has also been initiated too late in prior studies. Its application in the field has recently proven feasible. Variations of OCCPR, which deserve clinical trials inside and outside hospitals, include 'minimally invasive direct cardiac massage' (MIDCM), using a pocket-size plunger-like device inserted via a small incision and 'direct mechanical ventricular actuation' (DMVA), using a machine that pneumatically drives a cup placed around the heart. Other novel UALS approaches for further research include the use of an aortic balloon catheter to improve coronary and cerebral blood flow during SECPR, aortic flush techniques and a double-balloon aortic catheter that could allow separate perfusion (and cooling) of the heart, brain and viscera for optimal resuscitation of each. Decision-making, initiation of UALS methods and diagnostic evaluations must be rapid to maximize the potential for ROSC and facilitate decision-making regarding long-term circulatory support versus withdrawal of life support for hopeless cases. Research and development of UALS technique needs to be coordinated with cerebral resuscitation research. Copyright © 1997 Elsevier Science Ireland Ltd.</EA><CC>002B27B01</CC><FD>Arrêt cardiocirculatoire; Réanimation cardiocirculatoire; Recherche scientifique; Traitement; Technique; Optimisation; Homme</FD><FG>Appareil circulatoire pathologie</FG><ED>Cardiocirculatory arrest; Intensive cardiocirculatory care; Scientific research; Treatment; Technique; Optimization; Human</ED><EG>Cardiovascular disease</EG><GD>Aufbereiten; Optimierung</GD><SD>Paro cardiocirculatorio; Reanimación cardiocirculatoria; Investigación científica; Tratamiento; Técnica; Optimización; Hombre</SD><LO>INIST-21284.354000061533900018</LO><ID>97-0447781</ID></server></inist></record>Pour manipuler ce document sous Unix (Dilib)
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