Mechanical cardio resuscitation for asystole
We have great machines for shocking a heart out of various malfunctions.
But my understanding is that the only "machine" indicated for restarting a heart that has completely stopped (i.e., "flat-lined") is manual compression. I.e., even if you're a patient in a Level 1 trauma center, if you flat-line then all the machines get pushed aside and one person is going to start pushing on your chest above your heart to try to get it started. (And you might get a does of epinephrine. Oh, and if you're really "lucky" and they have your chest torn open then they'll reach in and compress the heart directly.) Is this accurate?
If so, isn't this weird? Pushing on the heart through the rib cage to get it to spontaneously start seems like trying to rescue someone drowning by standing on the shore and poking them with a stick.
We can electrically stimulate every muscle to contract. I understand that a functional heartbeat requires a coordinated series of contractions. An electrocardiogram can monitor the sequence of contractions in a functional heartbeat. Why can't it (or something like it) pump current back through its electrodes to stimulate a perfect heartbeat?
Or, if one could place arbitrary electrodes directly on a heart, could an electronic device force it to beat – indefinitely – when it has flat-lined? Or is there some reason that is not technically or medically feasible?
Again, it just seems weird that when the heart stops the current best practice is basically to just try "nudging" it to start.
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"Giving" electrical current to the heart does not necessarily translate to mechanical contractions.
The excitation-contraction coupling (as the sequence of electrical activation an muscle contraction is officially called), is not always a guarantee.
A cardiac arrest in many cases mirrors severe malfunction on the level of the micro-structures of the heart and a biochemical disarray in general. If you don't restore the pumping of the heart in seconds to minutes (even if this is crude and primitive-looking), the patient may not only die, but even worse they may "live" with severely depressed or completely absent brain function.
The only way, a "modern" way would help a "stopped" heart is if some futuristic nano-device could be employed rapidly to either correct micro anatomy and microphysiology in minutes, or replace and collaborate with the patient's native structures.
However, primitive it may seem to you, external manual compressions, if properly performed can make the difference (at a great percentage) between life and death.
The "electrical current- modern" approach works for patients with severe arrhythmias or conduction problems. In these cases the "mechanical part" of the heart is intact and you only replace the electrical function of a problematic conduction system or problematic natural pacemakers.
Even in this case, a properly performed placement of a temporary pacemaker is an awkward process that can take several minutes until successful (transcutaneous or transvenous) placement is established. If the patient is asystolic or almost asystolic (no-pulse), "primitive" compressions should be done until the pacemaker safely paces.
Unless a super enhanced swarm of nano-machines, that can navigate safely through the human body and correct problems rapidly and at will, emerges, no "sophisticated machines" will replace manual compressions. In fact, during resuscitation they have been proven much more valuable than artificial breathing, which is reflected in the change in the guidelines during the past 15 years.
Algorithms for Advanced Cardiac Life Support 2015
Acute treatment of sustained ventricular arrhythmias
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