Faster time to automated elevation of the head and thorax during cardiopulmonary resuscitation increases the probability of return of spontaneous circulation

Moore, Johanna C.; Duval, Sue; Lick, Charles; Holley, Joe; Scheppke, Kenneth; Salverda, Bayert; Rojas-Salvador, Carolina; Jacobs, Michael J.; Nystrom, Paul C.; Quinn, Ryan; Adams, Paul; Debaty, Guillaume; Hutchison, Mack; Mason, Charles W.; Martinez, Eduardo; Mason, Steven; Clift, Armando; Antevy, Peter; Coyle, Charles; Grizzard, Eric; Garay, Sebastian; Lurie, Keith G.; Pepe, Paul E.

doi:10.1016/j.resuscitation.2021.11.008

Cited by 16 publications

(13 citation statements)

References 20 publications

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“…As illustrated by Figure 1, animals were randomly divided in two experimental groups submitted to different head and thorax positions immediately after E-CPR initiation, that is, flat (0°; n = 6) or head-up position (+22 and +9 cm for head and thorax, respectively; n = 6) (12). The latter was achieved by an automated head- and thorax-up device (EleGARD Patient Positioning System), which allows a slow and gradual rise of 6 cm/min of the head and thorax over 2 minutes to a head and a thorax heights of 22 and 9 cm (12). Randomization was done using block size of 2.…”

Section: Methodsmentioning

confidence: 99%

Head and Thorax Elevation Prevents the Rise of Intracranial Pressure During Extracorporeal Resuscitation in Swine

Levy

Hutin

Polge

et al. 2022

Shock

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Aim: Head and thorax elevation during cardiopulmonary resuscitation improves cerebral hemodynamics and ultimate neurological outcome after cardiac arrest. Its effect during extracorporeal cardiopulmonary resuscitation (E-CPR) is unknown. We tested whether this procedure could improve hemodynamics in swine treated by E-CPR. Methods and Results: Pigs were anesthetized and submitted to 15 minutes of untreated ventricular fibrillation followed by E-CPR. Animals randomly remained in flat position (flat group) or underwent head and thorax elevation since E-CPR institution (head-up group). Electric shocks were delivered after 30 minutes until the return of spontaneous circulation (ROSC). They were followed during 120 minutes after ROSC. After 30 minutes of E-CPR, ROSC was achieved in all animals, with no difference regarding blood pressure, heart rate, and extracorporeal membrane of oxygenation flow among groups. The head-up group had an attenuated increase in ICP as compared with the flat group after cardiac arrest (13 ± 1 vs. 26 ± 2 mm Hg at the end of the follow-up, respectively). Cerebral perfusion pressure tended to be higher in the head-up versus flat group despite not achieving statistical difference (66 ± 1 vs 46 ± 1 mm Hg at the end of the follow-up). Carotid blood flow and cerebral oxygen saturation were not significantly different among groups. Conclusion: During E-CPR, head and thorax elevation prevents ICP increase. Whether it could improve the ultimate neurological outcome in this situation deserves further investigation.

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Section: Methodsmentioning

confidence: 99%

Head and Thorax Elevation Prevents the Rise of Intracranial Pressure During Extracorporeal Resuscitation in Swine

Levy

Hutin

Polge

et al. 2022

Shock

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“…Other studies focused on the use of a patient-positioning device that provides automated controlled elevation (ACE) of the head and thorax in combination with automated and/or ACD CPR with an ITD [16,17 ▪▪ ]. This triad of therapies is termed ACE CPR (Fig.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…The probability of ROSC for all rhythms declined 5.6% for every minute elapsed ( P = 0.006) between 4 and 12 min of ACE-CPR application. For shockable rhythms, the probability of ROSC declined 9% for every minute elapsed ( P = 0.006) in the 6-and 15 min 9-1-1 call to ACE-CPR time window [16].…”

Section: Clinical Studiesmentioning

confidence: 99%

“…This study introduced the idea of a potential therapeutic window of ACE-CPR, which is consistent with other time-sensitive emergencies in medicine such as time to thrombolytics in acute ischemic stroke or time to defibrillation in cardiac arrest. A limitation of this study is it was a registry-based observational study, without randomization or a control population [16].…”

Section: Clinical Studiesmentioning

confidence: 99%

“…The time from 9-1-1 call to device placement was used as a surrogate for the implementation of ACE-CPR. Restricted cubic-spline models and simple linear regression were used to assess the association of time from 9-1-1 call to ACE-CPR and the probability of ROSC [16].…”

Section: Clinical Studiesmentioning

confidence: 99%

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Head-up cardiopulmonary resuscitation

Moore

2023

Current Opinion in Critical Care

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Purpose of reviewThe purpose of this review was to provide an overview of head-up (HUP) CPR physiology, relevant preclinical findings, and recent clinical literature. Recent findingsRecent preclinical findings have demonstrated optimal hemodynamics and improved neurologically intact survival in animals receiving controlled head and thorax elevation with circulatory adjuncts. These findings are compared with animals in the supine position and/or receiving conventional CPR with the HUP position. There are few clinical studies of HUP CPR. However, recent studies have shown safety and feasibility of HUP CPR and improved near-infrared spectroscopy changes in patients with head and neck elevation. Additional observational studies have shown that HUP CPR performed with head and thorax elevation and circulatory adjuncts has a time-dependent association with survival to hospital discharge, survival with good neurological function, and return of spontaneous circulation. SummaryHUP CPR is a new and novel therapy increasingly used in the prehospital setting and discussed in the resuscitation community. This review provides a relevant review of HUP CPR physiology and preclinical work, and recent clinical findings. Further clinical studies are needed to further explore the potential of HUP CPR.

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Rapid Implementation of Head-Up CPR Is Associated With Survival Based on a Prespecified Propensity Score Matching Analysis: Response to the February 2023 Journal Club

Moore

Labarère

Lurie

et al. 2023

Annals of Emergency Medicine

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Faster time to automated elevation of the head and thorax during cardiopulmonary resuscitation increases the probability of return of spontaneous circulation

Cited by 16 publications

References 20 publications

Head and Thorax Elevation Prevents the Rise of Intracranial Pressure During Extracorporeal Resuscitation in Swine

Head and Thorax Elevation Prevents the Rise of Intracranial Pressure During Extracorporeal Resuscitation in Swine

Head-up cardiopulmonary resuscitation

Rapid Implementation of Head-Up CPR Is Associated With Survival Based on a Prespecified Propensity Score Matching Analysis: Response to the February 2023 Journal Club

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