Passive leg raising during cardiopulmonary resuscitation results in improved neurological outcome in a swine model of prolonged ventricular fibrillation

Dragoumanos, Vasileios; Iacovidou, Nicoletta; Chalkias, Athanasios; Lelovas, Pavlos; Koutsovasilis, Anastasios; Papalois, Αpostolos; Xanthos, Theodoros

doi:10.1016/j.ajem.2012.04.014

Cited by 17 publications

(43 citation statements)

References 29 publications

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“…In 2012, Dragoumanos et al induced VF in 20 healthy piglets and randomly assigned them to CPR with PLR versus conventional CPR [126]. To allow a standardised manoeuvre, a 45-degree triangular device was used to elevate the hips, knees and ankles of the pigs.…”

Section: Passive Leg Raising -From Intensive Care To Prehospital Cprmentioning

confidence: 99%

“…At this time, the EMS crews in Gothenburg carried a defibrillator with a height of 35 centimetres and measurements showed that a 35-centimetre feet elevation corresponds to a 20-degree hip joint flexion in a 170-to 175centimetre tall person. Dragoumanos et al [126] reported in 2012 that a 45degree passive leg raise during CPR in piglets significantly increased coronary perfusion pressure in the minute prior to the first shock. Based on this knowledge, PLR between 20 and 45 degrees was considered desirable.…”

Section: Paper IIImentioning

confidence: 99%

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Passive leg raising in out-of-hospital cardiac arrest

et al. 2019

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Background: The chances of survival after an out-of-hospital cardiac arrest (OHCA) are one in ten. The majority of survivors have no or relatively mild neurological sequelae. Interventions are time critical and well-timed management is challenging. All aspects of resuscitation in an OHCA are based on knowledge of clinically important actions and their timing in OHCA management. Randomised trials face ethical and legal barriers. The victim is unable to give informed consent and obtaining consent from a legal surrogate delays resuscitation actions. This highlights the need for observational efforts in cardiac arrest research, together with the further exploration of clinically relevant factors and their importance to survival chances in OHCA. Methods: Study I describes the importance of the number of defibrillations in OHCA and their association with survival chances. It is based on data from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR). Study II describes the implementation and feasibility of a direct pathway to immediate coronary angiography after OHCA and its outcome. Patients were screened in the field by ambulance crews and referred to the catheterisation laboratory after consultation with the interventionalist. Study III examines the effect of a basic manoeuvre (passive leg-raising, PLR) in cardiopulmonary resuscitation (CPR) in an observation comparing PLR with standard CPR. Study IV determines the association between ambulance response time and survival after an OHCA, based on data reported to the SRCR. Results: Study I: Between 1990 and 2015, 19,519 patients with a shockable rhythm were reported to the SRCR and included in the study. The chances of survival decreased as the number of defibrillations required increased. Among patients found in a shockable rhythm, 7.5% required more than 10 shocks. Among the witnessed cases, we identified 12 factors associated with survival to 30 days, one of which was the number of shocks that were delivered. Study II: Prehospital screening identified 86 OHCA patients, but only 58% fulfilled the given criteria for pathway activation. Among these, the angiography procedure was started within an hour after collapse in half the cases and the majority had a culprit lesion. Thirty per cent of the patients survived to 30 days and 92% of the survivors presented with a shockable rhythm. All survivors had a good cerebral performance or sufficient function to manage activities of daily life independently. Study III: The PLR manoeuvre was performed in 44% of the n=3,554 OHCA patients included in the study. Survival to 30 days was 7.9% among patients who received PLR and 13.5% among those who did not (OR 0.55; 95% CI 0.44-0.69; p < 0.0001). When matching 1:1 on a propensity score, the difference in 30-day survival between the two groups disappeared (OR 1.07; CI 0.80-1.44; p = 0.65). The matched comparison showed a 30-day survival rate of 8.6% in the PLR group versus 8.2% in the control group. Study IV: Survival chances after a witnessed OHCA decreased as ambulance respo...

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Section: Passive Leg Raising -From Intensive Care To Prehospital Cprmentioning

confidence: 99%

Section: Paper IIImentioning

confidence: 99%

Passive leg raising in out-of-hospital cardiac arrest

et al. 2019

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“…Passive leg raising (PLR) is a maneuver which involves the elevation of the lower limbs from the horizontal plane (Dragoumanos et al, 2012). The effect of PLR is to shift blood from the lower extremities toward the intra-thoracic compartment (Pottecher et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, the discussion related to PLR in CPR has been re-opened by clinicians and researchers. Axelsson et al found PLR can increase end-tidal carbon dioxide (PETCO2) during CPR (Axelsson et al, 2010); The on-going study by Jiménez-Herrera et al is investigating whether PLR can improve the 1-month survival rate of the patients who had out-of-hospital cardiac arrest (OHCA) (Jimenez-Herrera et al, 2014); Dragoumanos et al found that PLR during CPR produced significantly higher neurological scores in piglets (Dragoumanos et al, 2012). …”

Section: Introductionmentioning

confidence: 99%

Not Bad: Passive Leg Raising in Cardiopulmonary Resuscitation-A New Modeling Study

et al. 2017

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Aim: To evaluate, using a simulated haemodynamic circulation model, whether passive leg raising (PLR) is able to improve the effect during cardiopulmonary resuscitation (CPR); to expose the possible reasons why PLR works or not.Materials and Methods: We adapted a circulatory model for CPR with PLR. First we compared cardiac output (CO), coronary perfusion pressure (CPP), blood flow to heart (Qheart), and blood flow to neck and brain (Qhead) of standard chest compression-only CPR with and without PLR; second we simulated the effects of PLR in different situations, by varying the thoracic pump factor (TPF) from 0 to 1; third we simulated the effects when the legs are lifted to the different heights. Finally, we compared our results with those obtained from a published clinical study.Results: According to the simulation model, (1) When TPF is in the interval (0,1), CPP, CO, Qheart, and Qhead are improved with PLR, among them with half-thoracic/half-cardiac pump effect (TPF is 0.5), CPP, CO, Qhead, and Qheart increase the most (by 14, 14, 15, and 17%). (2) When TPF is 1 (pure thoracic pump, with an emphysema or extremely thick thorax), PLR has almost no effect on CPP, CO, and Qheart (−1, 2, and 0%), whereas Qhead is increased by 9%; (3) Regardless of whether there is a cardiac or thoracic pump effect, PLR is able to increase Qhead by 9–15%. (4) When the legs are lifted to 30° to the ground, the volume transferred from legs to upper body is 36% of the initial volume in legs; when the legs are lifted to 45°, the volume transferred is 43%; when the legs are lifted to 60°, the volume transferred is 47%; when the legs are lifted to 90°, the volume transferred is 50%.Conclusion: Generally PLR is able to achieve improved cerebral perfusion and coronary perfusion. In some extreme situations, it has no effect on cardiac output and coronary perfusion, but still improves cerebral perfusion. PLR could be a beneficial supplement to CPR, and it is not necessary to lift the legs too high above the ground.

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“…Dragoumanos et al [30] found in their animal study that the coronary perfusion pressure (CPP) also increased when PLR was performed during CPR and auto-transfusion of the aorta by PLR was the explanation. It is unclear whether this mechanism can be transferred to humans.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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BackgroundIt is estimated that about 275,000 inhabitants experience an out-of-hospital cardiac arrest (OHCA) every year in Europe. Survival in out-of-hospital cardiac arrest is relatively low, generally between five per cent and 10%. Being able to explore new methods to improve the relatively low survival rate is vital for people with these conditions. Passive leg raise (PLR) during cardiopulmonary resuscitation (CPR) has been found to improve cardiac preload and blood flow during chest compressions. The aim of our study is to evaluate whether early PLR during CPR also has an impact on one-month survival in sudden and unexpected out-of-hospital cardiac arrest (OHCA).Method/DesignA prospective, randomized, controlled trial in which all patients (≥18 years) receiving out-of hospital CPR are randomized by envelope to be treated with either PLR or in the flat position. The ambulance crew use a special folding stool which allows the legs to be elevated about 20 degrees. Primary end-point: survival to one month. Secondary end-point: survival to hospital admission to one month and to one year with acceptable cerebral performance classification (CPC) 1–2.DiscussionPLR is a simple and fast maneuver. We believe that the greatest benefit with PLR is when performed early in the process, during the first minutes of CPR and before the first defibrillation. To reach power this study need 3000 patients, we hope that this method article will encourage other sites to contact us and take part in our study.Trial registrationClinicalTrials.gov NCT01952197.

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Passive leg raising during cardiopulmonary resuscitation results in improved neurological outcome in a swine model of prolonged ventricular fibrillation

Cited by 17 publications

References 29 publications

Passive leg raising in out-of-hospital cardiac arrest

Passive leg raising in out-of-hospital cardiac arrest

Not Bad: Passive Leg Raising in Cardiopulmonary Resuscitation-A New Modeling Study

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

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