Controlled sequential elevation of the head and thorax combined with active compression decompression cardiopulmonary resuscitation and an impedance threshold device improves neurological survival in a porcine model of cardiac arrest

Moore, Johanna C.; Salverda, Bayert; Rojas-Salvador, Carolina; Lick, Michael; Debaty, Guillaume; Lurie, Keith G.

doi:10.1016/j.resuscitation.2020.09.030

Cited by 37 publications

(48 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This technique has also been evaluated in animal laboratory studies (also in concert with mechanical CPR and an impedance threshold device) with mixed outcomes, but those studies were not included in this review, which focused on clinical data. [18][19][20][21][22][23] Treatment Recommendations We suggest against the routine use of head-up CPR during CPR (weak recommendation, very low-certainty evidence).…”

Section: Consensus On Sciencementioning

confidence: 99%

2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group

Wyckoff¹,

Singletary²,

Soar³

et al. 2022

Circulation

View full text Add to dashboard Cite

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

show abstract

Section: Consensus On Sciencementioning

confidence: 99%

2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group

Wyckoff¹,

Singletary²,

Soar³

et al. 2022

Circulation

View full text Add to dashboard Cite

show abstract

“…Next, we excluded 27 articles (because they were review articles, not original studies, or posts/conference abstracts, studied human cadavers, not compare with supine position, lacked detailed data, letter to editor or post CPR). Initially, eight studies [ 14 – 18 , 21 , 22 , 28 ], including 147 pigs, were included; however, we excluded one study (that used different CPR methods with different angles) because of the lack of a comparison group [ 21 ]. Therefore, 7 studies with 131 subjects were ultimately analyzed in the meta-analysis (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Fourth, within 2–4 min of CSE, instead of the absolute HUP angle or rapid elevation, CerPP achieves 50% of baseline in 2.5 min and over 80% in 7 min under CSE HUP ACD + ITD CPR, as noted by a recent study [ 31 , 32 ]. Although the mechanism of CSE needs further research, Moore et al [ 21 ] revealed that HUP CPR had good neurologic survival outcomes in an animal model after combining 4 factors (using ACD + ITD CPR, the “priming” step, elevated head/chest up only and CSE). Overall, we considered that the “priming timing,” “sequencing of HUP” and “using ACD and ITD” during resuscitation are better able to achieve favorable neurological outcomes than just elevating the head and chest.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, facilitating venous return may increase CoPP, and a higher CoPP is associated with a higher ROSC rate [ 20 ]. Furthermore, with the combination of HUP ACD + ITD CPR, a recent animal study found that controlled sequential elevation (CSE) rather than a specific head-up angle could maximize CerPP and improve the ROSC rate and neurological outcome [ 21 ]. However, Park et al [ 22 ] demonstrated that head-up CPR could worsen the survival rate.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The effect of the head-up position on cardiopulmonary resuscitation: a systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

Objective Experimental studies of head-up positioning (HUP) during cardiopulmonary resuscitation (CPR) have had some degree of conflicting published results. The current study aim was to analyze and reconcile those discrepancies in order to better clarify the effects of HUP CPR compared to conventional supine (SUP) CPR. Methods Three databases (PubMed, EMBASE and Cochrane Library) were searched comprehensively (from each respective database's inception to May 2021) for articles addressing HUP CPR. The primary outcome to be observed was cerebral perfusion pressure (CerPP), and secondary outcomes were mean intracranial pressure (ICP), mean arterial pressure (MAP), coronary perfusion pressure (CoPP) and frequencies of return of spontaneous circulation (ROSC). Results Seven key studies involving 131 animals were included for analysis. Compared to SUP CPR, CerPP (MD 10.37; 95% CI 7.11–13.64; p < 0.01; I2 = 58%) and CoPP (MD 7.56; 95% CI 1.84–13.27, p = 0.01; I2 = 75%) increased significantly with HUP CPR, while ICP (MD − 13.66; 95% CI − 18.6 to –8.71; p < 0.01; I2 = 96%) decreased significantly. Combining all study methodologies, there were no significant differences detected in MAP (MD − 1.63; 95% CI − 10.77–7.52; p = 0.73; I2 = 93%) or frequency of ROSC (RR 0.9; 95% CI 0.31–2.60; p = 0.84; I2 = 65%). However, in contrast to worse outcomes in studies using immediate elevation of the head in a reverse Trendelenburg position, study outcomes were significantly improved when HUP (head and chest only) was introduced in a steady, graduated manner following a brief period of basic CPR augmented by active compression–decompression (ACD) and impedance threshold (ITD) devices. Conclusion In experimental models, gradually elevating the head and chest following a brief interval of circulatory priming with ACD and ITD devices can enhance CoPP, lower ICP and improve CerPP significantly while maintaining MAP. This effect is immediate, remains sustained and is associated with improved outcomes.

show abstract

“…In recent years, some studies have revealed that head-up position CPR could decrease ICP and improve CerPP [8], and that it may even improve coronary perfusion pressure (CoPP) [9] and increase the ROSC rate [10] in animal experiments. Compared to conventional CPR, in which the patient lies down at 0 degrees, elevating the head during CPR could accelerate brain venous return and the hydrostatic displacement of CSF from the cerebral ventricles to the spinal cavity [11].…”

Section: Introductionmentioning

confidence: 99%

The effect of the head-up position in cardiopulmonary resuscitation – A systematic review and meta-analysis

Huang

Chen

Lin

et al. 2021

Preprint

View full text Add to dashboard Cite

ObjectiveThe pros and cons of the head-up position (HUP) in cardiopulmonary resuscitation (CPR) have been controversial in previous studies. This study aims to clarify the effect of HUP CPR compared to supine position (SUP) CPR.MethodThree databases were comprehensively searched (PubMed, EMBASE and the Cochrane Library) for articles published from database inception to 10 May 2021. The primary outcome was cerebral perfusion pressure (CerPP). The secondary outcomes were mean intracranial pressure (ICP), mean artery pressure (MAP), coronary artery perfusion pressure (CoPP) and the return of spontaneous circulation (ROSC) rate.ResultA total of 7 studies including 138 animals were included. We found that CerPP (SMD, 1.58; 95% CI, 0.98–2.19; p < 0.01; I2 = 51%) and ICP (SMD, -3.59; 95% CI, -5.16– -2.02; p < 0.01; I2 = 87%) were decreased significantly in the HUP group. HUP had a similar MAP (SMD, -0.54; 95% CI, -1.75–0.66; p = 0.38; I2 = 87%) and ROSC rate (RR, 0.9; 95% CI, 0.31–2.60; p = 0.84; I2 = 65%) to SUP. In addition, there was an increased CoPP trend in HUP, but the difference was not statistically significant (SMD, 0.92; 95% CI, -0.24–2.08; p = 0.12; I2 = 84%)ConclusionThe HUP 30° in active compression-decompression CPR (ACD-CPR) with an impedance threshold device (ITD) can increase CerPP by significantly lowering ICP and maintaining MAP compared to SUP, and the effect is immediate and lasts the whole CPR duration. In addition, CoPP might also be increased compared to that with SUP.

show abstract

Controlled sequential elevation of the head and thorax combined with active compression decompression cardiopulmonary resuscitation and an impedance threshold device improves neurological survival in a porcine model of cardiac arrest

Cited by 37 publications

References 27 publications

The effect of the head-up position on cardiopulmonary resuscitation: a systematic review and meta-analysis

The effect of the head-up position in cardiopulmonary resuscitation – A systematic review and meta-analysis

Contact Info

Product

Resources

About