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December 22, 2016
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September 6, 2011
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June 4, 1954
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Sanitized Copy Approved for Release 2011/09/14 :CIA-RDP80-00809A000700180433-0 STAT Sanitized Copy Approved for Release 2011/09/14 :CIA-RDP80-00809A000700180433-0 Sanitized Copy Approved for Release 2011/09/14 :CIA-RDP80-00809A000700180433-0 ~ NEGOVSKIY'S WORK ON RESUSCTTATION OF CLINICALLY DEAD Meditainskiy Rabotnik, Vol %VII No 20 Moscow, 9 Mar 1454 [Comment; The following is a review, by Prof A. Vishnevskiy, of V. A. Negovskiy's book Patofiziologiys 1 Terspiytt Agnnii 1 Klinichesko Smerti (Pathophysiology and Therapy of Agctty artd Clinical death pub- lished by Medgiz, Moscow, 195}+.] In his bnnk, v. h. Negovskiy, Stalin Prize Laureate, seeks to familiarize practical physicians with she pathophysiolcp~ and therapy of agony and clinical aeatn. USSk scientists have Cade an important contribution to the solution of the problem of resuscitation. Negevskiy states thst,ia 1871, I. Kostarev had already carried out an arterial transfusion to s septic patient [a patient suffering from septice:,is~. This was the first arterial transfusion reported. Of great significance ir, the work cf F. .4. Attdreyev, uho opened u~ a new chapter in work on the problem of resuscitation. After a detailed description of the method cf restoring the vital functions of the organism which has been developed in the lsbora?.ory directed by him, Negovskiy discusses some typical characteristics of metabolism during extinction 2nd restoration of vital .."unct.icns of the organism. Chapter 2 cummsrizes the results of work by certain ccllaborstor, of tegovskiy. Chapter 2 also brings out the rtage in the process of dying and is the cessation of vital functions at which disturbance of metabolism in tissue:: sets in. fegovskiy discucseo ?h? problem cf the sources of energy at the expense of which the o` vital. functions, osr'.i^u l.,rly those o: the central nervous system, takes place. It is shown :,, w}tat, stage of resuscitation the restored nervous system as::ures the return ~, tissue metabolism t.o s normal state. Negovskiy 3emnnstr:'.es how :aerobicais is rn+dturlly replaced by glycolysis as the tertr,inal coaditt,.ns dev~tlep and divisi::n:~ :_' fate central. nervous system are gradually elim_nated. As clinira ;lelth sets zn, 'here is ?: rcluct.i.,n cf :.he level of glycolysis. The sources which supply energ;,? t, the brain '_:a ue tre greatly impoverished at this stage. Creative phc,?sphate is completely absent, chile the consent of glycogen and of easily hydrolyzable phosph::?e (adenosine triphoophoric acid) is reduced to ; minimum. The first stage of the restoration of ti:e centr,a'_ nervous system takes place meanly at the expense c" glycolysis. Only st the end cf the first hour of resuscitation, when the cerebral cortex is revived and it.; bioelectrical currents Ire completely restored, is there tnansiticr. from the glycolytic to the oxidative way of the utilization of carbohydrates. According to Negovskiy, the state of oxygen s?arvation of in organism which hes beer. subjected to clinical death ecr.- tinues until the functions of the cortex of the large hemisphere are restored more or less completely and the organism acquires *.he capacity to switch on the cortic?1 compensatory mech~:n isms, if necessary. Negovskiy arrives at the conclu- sion that the restoration ~f the carbohydrate metabolism to normal depends on the time at which `.he functioning of the cerebral cortex `tas been restored. In Chapter 3, the fun:iamental laws regulating the restoration of cardio- vascular activity are expounded, and a theoretical treatment of infra-arterial centripetal t.rsnsfusien cf b1c,d under pressure is given. It is noted that Sanitized Copy Approved for Release 2011/09/14 :CIA-RDP80-00809A000700180433-0 Sanitized Copy Approved for Release 2011/09/14 :CIA-RDP80-00809A000700180433-0 ~ restorstion of the normal metabolism cf the heart by ad,ninistraticn of oxygen and of nourishing substances is closely connected with irritation of the recep?.or apparatus. Experimental data shoe that when the receptors of the arterial blood ,path are depressed, it is not possible to restore effectively the functioning of the cardiovascular system. In Negovskiy's book, the importance of the restoration of a high level of neural regulation of the activity of the cardiovascular system la emphasized. 7n complete accordance with the work done by Academician K. M. Bykov, Negovkaiy shows that resr.itutiorr of the cortical level of regula- tion oC the cardiovascular system is the most important and conclusive condition for the restoration of that system. Chapter 4 clarifies the dynamics of the restorstion of respiratory activity. Negovskiy convincingly demonstrates that reflex stimulation is the most effective me*..hod of restoring the respiratory activity. This restoration is achieved by artificial respiration by a respirator which assures that air is blown into the lungs. For successful resuscitation, early restoration o.? the functioning of the bulbar centers is of great Importance. The nature of the extinction and restorstion of cortical and subcorticsl functions during the process of dying and restoration of vital functions of the organism is clarified in Ne,uvskiy's book. The author also shows that the functioning of the cerebral cortex ceases st the earliest stage during the process of dying and is restored last during the process of resuscitation. Zn accordance with I. P. Pavlov's and E. A. Asratyan's work, Negovskiy shoes the prominent role which the cerebral cortex plays in the compensation of disturbances that occur in an organism sub,jecte3 to clinical death. The author pays considerable attention ro srr analysis of those disturbances of the cerebral cortex which may take place In resuscitated patients who have suffered a long clinical death. Negovskiy remarks with ~ustificatian that the problem of resuscitation of ,i higher or wnlsm amounts substanr,ially to reator~tion of the functioning of the cerebral cortex. In discussing the complex method c+.' restoring the vital functions of the body, the author summarizes experience acquired in clinical application of this method to treat terminal conditions brought about by lethal blood loss, acute shock, agony, and ciinicrl death. Ir. the clear, detailed chapter dealing with this problem, he outlines the procedures to he followed by a surgeon when arterial transfusion of blood is :rppl!ed in cases cf hemorrhage that cannot be stopped. The book pays particular attention to surgical anesthesia carried out Sn terminal states brought. about by factors which require surgical interference. Experimental results and clinical observations curried out by the author have shown that deep anesthesia, when combined with blood Losses or intoxication (as, for Snstance, in peritonitis, sepsis, c;r intestinal obstructions), may re- sult in the same serious consequences as clinical death which has continued for more than 5-6 minutes. In conditions of this kind, the positive effect of applying local anesthesia according to A. Vishnevskiy's method is brought out (see page 197). It is shown local anesthesia does not sub,Ject to a strain the nervous system which has been traumatized by snemizstion or by other factors xhich may result in the development of terminal conditions. In conclusion, the author discusses problems which require Smmediate experi- mental and clinical study, The author states that, although fundamental investi- gations must still be carried out, all achievements in the field of therapy of terminal conditions which are already available should be applied at clinics, particularly at the surgical and obstetric-gynecologic clinic. Sanitized Copy Approved for Release 2011/09/14 :CIA-RDP80-00809A000700180433-0 Sanitized Copy Approved for Release 2011/09/14 :CIA-RDP80-00809A000700180433-0 Sanitized Copy Approved for Release 2011/09/14 :CIA-RDP80-00809A000700180433-0 important fault is uneven treatment of lsomeoproblemss Some chapters are nottas xell xritten as others and there Ss a lack of experimental data on the investi- gation of the conditioned-reflex activity in resuscitated animals. There is an absence oP data on Negovakiy's clinical observations on the dynamics of extinc- tion and restoration of the second signal system. As far as this problem is concerned, the author limits himself to an analysic of published data. There is also a lack of information on supplementary methods for the treatment of patients who had suffered clinical death and had been revived. Nevertheless, on the xhole, Negovskiy's book presents in a sober and ob- ~ective manner data pertaining to the problem of the resuscitation of vital functions of the organism. It is permeated with a spirit of optimism and of firm assurance that Soviet science will soave this Smportant problem success- fully on the basis oP extensive correlation of theoretical investigations with clinical procedures and procedures applied in practical medicine. In general, there can be no doub? that Negovskiy's book is destined to become a valuable manual for physicians, primarily surgeons and obstetricians. STAT