Resuscitation of the Heart from Ventricular Fibrillation with Drugs Combined with Electric Shock. ∗

Abstract

Hoffa and Ludwig 1 demonstrated that electrical stimulation of the mammalian heart led to ventricular fibrillation and death. Prevost and Battelli 2 studied the effect of electric currents on the heart and reported that a brief countershock of sufficient strength applied directly to the heart through an electrode placed on the ventricles would produce a brief period of complete cardiac standstill from which coördinated ventricular beats might be resumed. Cardiac massage was found necessary preceding the countershock when the ventricular fibrillation had existed longer than 15 seconds. Hooker, Kouwenhoven and Langworthy 3 found that currents of 0.4 amperes and less applied directly through the heart cause ventricular fibrillation, while currents of 0.8 amperes and over will stop the fibrillation. They advised the central carotid injection of calcium chloride and adrenaline after countershock as an aid in restoring a vigorous beat. Wiggers 4 emphasized the importance of cardiac massage preceding the electric shock to improve the nutrition of the myocardium and he reported success in reviving 85% of fibrillating dog hearts.

The method of cardiac massage and electric shock with a current of approximately 1.5 amperes applied through the heart, with electrodes 3.5 by 9 cm. placed on each side of the heart, was used in the surgical laboratory in cases of ventricular fibrillation developing in the dog's heart during experimental cardiac surgery. Bare metal electrodes were used on the heart; they do not cause local burning if there is a large area of contact with the heart. It is preferable to make the electrodes of a metal that will not corrode. Success was obtained in about half the cases, but there were many failures, the cause of which was not apparent. After it was determined that procaine hydrochloride is a myocardial depressant 5 and readily absorbed from the epicardium, this drug was applied over the surface of the heart in doses up to 20 mg. per kilo of body weight in the hearts difficult to revive, and it was found that a higher percentage could be revived.