Passive leg raise (PLR) during cardiopulmonary (CPR) – a method article on a randomised study of survival in out-of-hospital cardiac arrest (OHCA)

Herrera, María; Azeli, Youcef; Valero-Mora, Eva; Lucas-Guarque, Isaac; López-Gomariz, Alfonso; Castro-Naval, Elena; Axelsson, Christer

doi:10.1186/1471-227x-14-15

Cited by 8 publications

(10 citation statements)

References 36 publications

(30 reference statements)

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“…The application is linked to the Swedish Registry of Out-Of-Hospital-Cardiac-Arrests. The application was originally created for a randomized trial on registry patients to measure the effectiveness of passive leg raising during OHCA [ 23 ] and collects specific data for the ReCaPTa Study relating to the onset of symptoms prior to collapse.…”

Section: Methodsmentioning

confidence: 99%

The ReCaPTa study - a prospective out of hospital cardiac arrest registry including multiple sources of surveillance for the study of sudden cardiac death in the Mediterranean area

Azeli¹,

Barbería²,

Herrera

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundCardiovascular diseases are one of the leading causes of death in the industrialized world. Sudden cardiac death is very often the first manifestation of the disease and it occurs in the prehospital setting.The determination of the sudden cardiac death phenotype is challenging. It requires prospective studies in the community including multiple sources of case ascertainment that help to identify the cause and circumstances of death.The aim of the Clinical and Pathological Registry of Tarragona (ReCaPTa) is to study incidence and etiology of Sudden Cardiac Death in the Tarragona region (Catalonia, Spain).MethodsReCaPTa is a population-based registry of OHCA using multiple sources of surveillance. The population base is 511,662. This registry is compiled chronologically in a relational database and it prospectively contains data on all the OHCA attended by the EMS from April 2014 to April 2017. ReCaPTa collects data after each emergency medical assistance using an online application including variables of the onset of symptoms. A quality control is performed and it permits monitoring the percentage of cases included by the emergency crew. Simultaneously, data from the medico-legal autopsies is taken from the Pathology Center of the area. All the examination findings following a specific protocol for the sudden death study are entered into the ReCaPTa database by one trained person. Survivors admitted to hospital are followed up and their clinical variables are collected in each hospital. The primary care researchers analyze the digital clinical records in order to obtain medical background. All the available data will be reviewed after an adjudication process with the aim of identifying all cases of sudden cardiac death.DiscussionThere is a lack of population-based registries including multiple source of surveillance in the Mediterranean area. The ReCaPTa study could provide valuable information to prevent sudden cardiac death and develop new strategies to improve its survival.

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Section: Methodsmentioning

confidence: 99%

The ReCaPTa study - a prospective out of hospital cardiac arrest registry including multiple sources of surveillance for the study of sudden cardiac death in the Mediterranean area

Azeli¹,

Barbería²,

Herrera

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…Manual CPR was started, and if there were no exclusion criteria, randomization and allocation concealment was performed via an opaque and sealed envelope system. The randomization process and the description of the protocol are detailed in the published study design [20]. PLR was performed within the first 5 min after the arrival of the first ambulance and was maintained until the end of CPR or until the patient presented ROSC.…”

Section: Intervention and Randomizationmentioning

confidence: 99%

Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial

et al. 2021

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Background There are data suggesting that passive leg raising (PLR) improves hemodynamics during cardiopulmonary resuscitation (CPR). This trial aimed to determine the effectiveness and safety of PLR during CPR in out-of-hospital cardiac arrest (OHCA). Methods We conducted a randomized controlled trial with blinded assessment of the outcomes that assigned adults OHCA to be treated with PLR or in the flat position. The trial was conducted in the Camp de Tarragona region. The main end point was survival to hospital discharge with good neurological outcome defined as cerebral performance category (CPC 1–2). To study possible adverse effects, we assessed the presence of pulmonary complications on the first chest X-rays, brain edema on the computerized tomography (CT) in survivors and brain and lungs weights from autopsies in non-survivors. Results In total, 588 randomized cases were included, 301 were treated with PLR and 287 were controls. Overall, 67.8% were men and the median age was 72 (IQR 60–82) years. At hospital discharge, 3.3% in the PLR group and 3.5% in the control group were alive with CPC 1–2 (OR 0.9; 95% CI 0.4–2.3, p = 0.91). No significant differences in survival at hospital admission were found in all patients (OR 1.0; 95% CI 0.7–1.6, p = 0.95) and among patients with an initial shockable rhythm (OR 1.7; 95% CI 0.8–3.4, p = 0.15). There were no differences in pulmonary complication rates in chest X-rays [7 (25.9%) vs 5 (17.9%), p = 0.47] and brain edema on CT [5 (29.4%) vs 10 (32.6%), p = 0.84]. There were no differences in lung weight [1223 mg (IQR 909–1500) vs 1239 mg (IQR 900–1507), p = 0.82] or brain weight [1352 mg (IQR 1227–1457) vs 1380 mg (IQR 1255–1470), p = 0.43] among the 106 autopsies performed. Conclusion In this trial, PLR during CPR did not improve survival to hospital discharge with CPC 1–2. No evidence of adverse effects has been found. Clinical trial registration ClinicalTrials.gov: NCT01952197, registration date: September 27, 2013, https://clinicaltrials.gov/ct2/show/NCT01952197.

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“…The plan was to include 300 patients in each group during the rst three years of the study in the whole district of Tarragona and 188 patient in each group for the region of Camp de Tarragona. (15).…”

Section: Intervention and Randomizationmentioning

confidence: 99%

“…Manual CPR was started, and if there were no exclusion criteria, randomization and allocation concealment was performed via an opaque and sealed envelope system. The randomization process and the description of the protocol are detailed in the published study design (15). PLR was performed within the rst 5 minutes after the arrival of the rst ambulance and was maintained until the end of CPR or until the patient presented return of spontaneous circulation (ROSC).…”

Section: Intervention and Randomizationmentioning

confidence: 99%

Clinical Outcomes and Safety of Passive Leg Raising in Out-of-Hospital Cardiac Arrest. A Randomized Clinical Trial.

Azeli

Bardajı́

Barbería³

et al. 2021

Preprint

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Background: There are data suggesting that passive leg raising (PLR) improves hemodynamics during cardiopulmonary resuscitation (CPR). This trial aimed to determine the effectiveness and safety of PLR during CPR in out-of-hospital cardiac arrest (OHCA).Methods: We conducted a randomized clinical trial with blinded assessment of the outcomes that assigned adults OHCA to be treated with PLR or in the flat position. The trial was conducted in the Camp de Tarragona region. The main end point was survival to hospital discharge with good neurological outcome defined as Cerebral Performance Category (CPC 1-2). To study possible adverse effects, we assessed the presence of pulmonary complications on the first chest X-rays in survivors and lungs weight from autopsies in non-survivors. Results: In total, 445 randomized CPR attempts were included, 234 were treated with PLR and 211 were controls. Overall, 71.5% were men and the median age was 69 IQR (58-78) years old. At hospital discharge, 4.3% in the PLR group and 4.7% in the control group were alive with CPC 1-2 (OR 0.9; 95% CI 0.4-2.2, p=0.81). A higher survival at hospital admission was found among patients with a shockable rhythm, but there were no significant differences (OR 1.6; 95% CI 0.8-3.4, p=0.18). There were no differences in pulmonary complication rates in chest X-rays (25.9% vs 17.9%, p=0.47) or lung weight 1223 IQR (909.5-1500) mg vs. 1239 IQR (900-1507) mg. Conclusion: In this trial, PLR during CPR did not improve survival to hospital discharge with CPC 1-2. No evidence of adverse effects has been found.Clinical Trial Registration: ClinicalTrials.gov: NCT01952197, registration date: Sept 27, 2013, https://clinicaltrials.gov/ct2/show/NCT01952197.

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Passive leg raise (PLR) during cardiopulmonary (CPR) – a method article on a randomised study of survival in out-of-hospital cardiac arrest (OHCA)

Cited by 8 publications

References 36 publications

The ReCaPTa study - a prospective out of hospital cardiac arrest registry including multiple sources of surveillance for the study of sudden cardiac death in the Mediterranean area

The ReCaPTa study - a prospective out of hospital cardiac arrest registry including multiple sources of surveillance for the study of sudden cardiac death in the Mediterranean area

Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial

Clinical Outcomes and Safety of Passive Leg Raising in Out-of-Hospital Cardiac Arrest. A Randomized Clinical Trial.

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