Resuscitation of all cardiac arrests from 1901 to 1960 exclusively
used direct compression of the heart and produced
considerable success (28% survival).74 In the modern era,
however, open cardiac massage is rarely taught or applied even
though it has been shown to provide superior cardiac output in
animals100 and humans,101 better perfusion pressure,102 improved
neurological outcome,103 and an increased likelihood of
successful resuscitation when instituted in a timely fashion (after
15 minutes of conventional CPR).102 This last point is critical
because human trial data suggest that converting to open cardiac
massage after 20 minutes of closed CPR does not improve
survival.104 As we strive to realize the goal of full neurological
recovery after cardiac arrest, future investigations should examine
the strategy of initiating open cardiac massage by trained
individuals if closed-chest CPR for15 minutes (or less) fails to
resuscitate victims.