Rupture of the Aorta During Closed-Chest Cardiac Massage

IN 1960, Kouwenhoven, Jude, and Knickerbocker¹described 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.²⁻⁵Cotlar et al²reported 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.⁴,⁶,⁷Most 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 al⁴reported autopsy results of 46 patients. Fifteen had rib fractures, six