IN 1960, Kouwenhoven, Jude, and Knickerbocker1 described the technique of closed-chest cardiac massage. They advocated it as a safe and simple method of cardiac resuscitation, available to physicians both in and out of the hospital. Since 1960, other reports have appeared attesting to the efficacy of the techinique.2-5 Cotlar et al2 reported that compared to operating room survival rates of 10% to 20% when open-chest massage was exclusively used, closed-chest massage is presently giving a 50% to 70% survival.
The procedure is not without complications.4,6,7 Most of these are rib or sternal fractures, but bone marrow emboli, hemothorax, hemopericardium, pneumothorax, mediastinal emphysema, gastric rupture, and lacerations of spleen, liver, and blood vessels also occur. It is difficult to ascertain the percentage of patients who have one or more of these complications. Baringer et al4 reported autopsy results of 46 patients. Fifteen had rib fractures, six