The primary management of global myocardial ischemia of cardiac arrest is re-establishment of myocardial and systemic blood flow. The discovery by Kouwenhoven.,.

eta! (I960) that myocardial and systemic blood flow could be generated by external compression of the chest ushered in the era of modern cardiopulmonary resuscitation. External chest compression became the standard of mechanical interventions intended to generate circulation during cardiac arrest.

Unfortunately, standard techniques of manual or mechanical external chest compression generate cardiac outputs of less than 30 per cent of normal; coronary blood flows are correspondingly reduced. Therefore alternative techniques have been investigated in an effort to increase cardiac output and both coronary and cerebral blood flows. Newly proposed interventions can be classified as either modifications of chest compression or the use of intravascular techniques. In addition, open-chest cardiac massage continues as an appropriate option. Mechanical interventions for maintaining systemic perfusion during cardiac arrest will be addressed in this chapter.

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