TY - JOUR T1 - INTRAPERICARDIAL MEDICATION AND MASSAGE IN THE TREATMENT OF ARREST OF THE HEART JF - Journal of Pharmacology and Experimental Therapeutics JO - J Pharmacol Exp Ther SP - 31 LP - 55 VL - 7 IS - 1 AU - JAMES A. GUNN AU - PHILIP A. MARTIN Y1 - 1915/07/01 UR - http://jpet.aspetjournals.org/content/7/1/31.abstract N2 - 1. Atropine, pilocarpine and adrenine, when injected into the pericardial sac in the rabbit can rapidly produce their characteristic effects on the heart up to a certain point. The immediate action obtained in this way is a local action on the heart and not simply due to absorption of the drugs into the general circulation. 2. In performing massage of the arrested heart with a view to reviving the spontaneous contractions, the following points are of importance: Compression should be gradual and relaxation abrupt. The rate of compression should be at most less than half the normal heart-rate. Massage should be regularly interrupted at short intervals for a few seconds to allow the spontaneous beats to develop. When the heart is arrested, massage, properly performed, acts both as an artificial circulation and as a mechanical stimulus to the heart muscle. Massage can be performed in the following ways, arranged in order of efficacy: (1) by direct compression of the heart through an opening in the thoracic wall; (2) by compression of the heart above the diaphragm through an opening in the abdominal wall; (3) by simple compression of the abdomen; (4) by simple compression of the thorax. 3. Direct thoracic massage combined with intrapericardial injection of adrenine can revive the heart in practically any case of chloroform-poisoning in the rabbit, even though the treatment be not begun until fifteen minutes or more after the heart has completely ceased to beat. In about 70 per cent of cases recovery can be obtained if treatment is commenced ten minutes after arrest of the heart by the following procedure: artificial respiration through a tube in the trachea; intrapericardial injection of adrenine; massage through an opening in the abdomen. If, when the heart has been started, the blood pressure continues low, and the heart beats remain (chiefly as a consequence of this) feeble, speedy and permanent improvement of the heart and blood-pressure can be obtained by intravenous injection of either adrenine or pituitrin. Treatment on these lines is suggested for cardiac arrest in the human subject, occurring either in chloroform-poisoning or in other conditions in which general recovery might be anticipated to result from resuscitation of the heart. ER -