Abstract
Chest compressions during cardiopulmonary resuscitation (CPR) increase arterial and venous pressures, delivering simultaneous bidirectional high-pressure compression waves to the brain. We hypothesized that this may be detrimental and could be partially overcome by elevation of the head during CPR. Female Yorkshire farm pigs (n=30) were sedated, intubated, anesthetized, and placed on a table able to elevate the head 30° (15cm) (HUP) and the heart 10° (4cm) or remain in the supine (SUP) flat position during CPR. After 8minutes of untreated ventricular fibrillation and 2minutes of SUP CPR, pigs were randomized to HUP or SUP CPR for 20 more minutes. In Group A, pigs were randomized after 2minutes of flat automated conventional (C) CPR to HUP (n=7) or SUP (n=7) C-CPR. In Group B, pigs were randomized after 2minutes of automated active compression decompression (ACD) CPR plus an impedance threshold device (ITD) SUP CPR to either HUP (n=8) or SUP (n=8). The primary outcome of the study was difference in CerPP (mmHg) between the HUP and SUP positions within groups. After 22minutes of CPR, CerPP was 6±3mmHg in the HUP versus -5±3 in the SUP (p=0.016) in Group A, and 51±8 versus 20±5 (p=0.006) in Group B. Coronary perfusion pressures af...Continue Reading
References
Jan 1, 1985·Circulation Research·A D GuerciN Chandra
Apr 1, 1984·Circulation·J R MichaelM L Weisfeldt
Mar 15, 1995·Circulation·K G LurieK Mulligan
Sep 1, 1993·Circulation·K H LindnerF W Ahnefeld
Apr 29, 1998·Chest·K G LurieK H Lindner
Nov 26, 2008·Circulation·Bentley J BobrowKarl B Kern
Jan 22, 2011·Lancet·Tom P AufderheideKeith G Lurie
Sep 2, 2011·The New England Journal of Medicine·Tom P AufderheideUNKNOWN Resuscitation Outcomes Consortium (ROC) Investigators
Dec 3, 2014·Resuscitation·Guillaume DebatyKeith Lurie
Citations
Mar 28, 2017·Current Opinion in Critical Care·Johanna C MooreDemetris Yannopoulos
May 4, 2017·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Tae Han KimChu Hyun Kim
Feb 12, 2019·Heart Failure Reviews·Athanasios ChalkiasTheodoros Xanthos
Feb 16, 2019·Critical Care Medicine·Paul E PepeJohanna C Moore
Oct 2, 2019·Clinical and Experimental Emergency Medicine·Yong Joo ParkHyun Ho Ryu
Oct 8, 2020·Resuscitation·Johanna C MooreKeith G Lurie
Jan 2, 2021·Resuscitation·Helene DuhemKeith G Lurie
Mar 3, 2020·Resuscitation·Johanna C MooreKeith G Lurie
Mar 21, 2021·Best Practice & Research. Clinical Anaesthesiology·Hans van SchuppenMarkus W Hollmann
Mar 27, 2021·Current Opinion in Critical Care·Lauge VammenAsger Granfeldt
May 27, 2021·Critical Care : the Official Journal of the Critical Care Forum·Youcef AzeliMaria F Jiménez-Herrera
Aug 10, 2021·Journal of the American Heart Association·James M HorowitzFelipe Teran
Aug 16, 2021·The American Journal of Emergency Medicine·Ki Hong KimHyun Jeong Kang
Jun 7, 2020·Resuscitation·Guillaume DebatyKeith G Lurie