Reperfusion injury protection during Basic Life Support improves circulation and survival outcomes in a porcine model of prolonged cardiac arrest

Debaty, Guillaume; Lurie, Keith G.; Metzger, Anja; Lick, Michael; Bartos, Jason A.; Rees, Jennifer; McKnite, Scott; Puertas, Laura; Pepe, Paul E.; Fowler, Raymond L.; Yannopoulos, Demetris

doi:10.1016/j.resuscitation.2016.05.008

Cited by 11 publications

(7 citation statements)

References 31 publications

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“…However, the VF prolonged arrest model is commonly used. [24][25][26][27] While this study provides definitive evidence of an increase in blood flow to the brain during prolonged HUP CPR, it is unknown if this benefit will translate into an increase in long-term survival with favorable brain function. Further study is needed in this regard.…”

Section: Discussionmentioning

confidence: 84%

Head and thorax elevation during active compression decompression cardiopulmonary resuscitation with an impedance threshold device improves cerebral perfusion in a swine model of prolonged cardiac arrest

et al. 2017

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Section: Discussionmentioning

confidence: 84%

Head and thorax elevation during active compression decompression cardiopulmonary resuscitation with an impedance threshold device improves cerebral perfusion in a swine model of prolonged cardiac arrest

et al. 2017

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“…Obviously, these studies cannot be performed in humans, and the ventricular fibrillation swine model is commonly used and accepted as the cardiac arrest model for animals. 29 Importantly, pig anatomy is different from the human body. To establish the heads‐up tilt position for pigs, the upper limbs were stretched by ropes to allow the body to hang on the tilted table.…”

Section: Discussionmentioning

confidence: 99%

“…The most challenging downfall in heads‐up CPR remains the inability to experiment with these new techniques on humans and the reliability of animal modeling. Obviously, these studies cannot be performed in humans, and the ventricular fibrillation swine model is commonly used and accepted as the cardiac arrest model for animals 29 . Importantly, pig anatomy is different from the human body.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of heads‐up CPR compared to supine CPR positions: Systematic review and meta‐analysis

Varney

Motawea

Mostafa

et al. 2022

Health Science Reports

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Background and Aim: Cardiopulmonary resuscitation (CPR) in full-coded patients requires effective chest compressions with minimal interruptions to maintain adequate perfusion to the brain and other vital organs. Many novel approaches have been proposed to attain better organ perfusion compared to traditional CPR techniques. The purpose of this review is to investigate the safety and efficacy of heads-up CPR versus supine CPR.Methods: We searched PubMed Central, SCOPUS, Web of Science, and Cochrane databases from 1990 to February 2021. After the full-text screening of 40 eligible studies, only seven studies were eligible for our meta-analysis. We used the RevMan software (5.4) to perform the meta-analysis.Results: In survival outcome, the pooled analysis between heads-up and supine CPR was (risk ratio = 0.98, 95% confidence interval [CI] = 0.17-5.68, p = 0.98). The pooled analyses between heads-up CPR and supine CPR in cerebral flow, cerebral perfusion pressure and coronary perfusion pressure outcomes, were (mean difference [MD] = 0.10, 95% CI = 0.03-0.17, p = 0.003), (MD = 12.28, 95% CI = 5.92-18.64], p = 0.0002), and (MD = 8.43, 95% CI = 2.71-14.14, p = 0.004), respectively. After doing a subgroup analysis, cerebral perfusion was found to increase during heads-up CPR compared with supine CPR at 6 min CPR duration and 18 to 20 min CPR duration as well. Conclusion:Our study suggests that heads-up CPR is associated with better cerebral and coronary perfusion compared to the conventional supine technique in pigs' models. However, more research is warranted to investigate the safety and efficacy of the heads-up technique on human beings and to determine the best angle for optimization of the technique results.

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“…The transferability of experimental findings from healthy, young pigs to real-life human SCA is a common concern across the included studies. While porcine models of cardiac arrest had been extensively developed and used in SCA research over decades, they were not without limitations ( 30 ). For example, the lower limbs of swine differ significantly from human equivalents in terms of the smaller blood volume.…”

Section: Discussionmentioning

confidence: 99%

The role of head-up cardiopulmonary resuscitation in sudden cardiac arrest: a systematic review and meta-analysis

Tan¹,

Han²,

Tan³

et al. 2022

Ann Transl Med

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Background Head-up cardiopulmonary resuscitation (HU-CPR) is an experimental treatment for sudden cardiac arrest (SCA), where cardiopulmonary resuscitation (CPR) is performed in a ramped position. We evaluated whether HU-CPR improved survival and surrogate outcomes as compared to standard CPR (S-CPR). Methods Studies reporting on HU-CPR in SCA were searched for in PubMed, Embase and Cochrane Library from inception to May 1st 2021. Outcomes included neurologically-intact survival, 24-hour-survival, intracranial pressure (ICP), cerebral perfusion pressure (CerPP) and brain blood flow (BBF). Risk of bias was assessed using the GRADE assessment tool and Newcastle Ottawa Scale. Fixed- and random-effects models were used to estimate the pooled effects of HU-CPR at 30 degrees. Results Thirteen articles met the criteria for inclusion (11 animal-only studies, one before-and-after human-only study, one study that utilized human- and animal-cadavers). Among animal studies, the most common implementation of HU-CPR was a 30-degree upward tilt of the head and thorax (n=7), while four studies investigated controlled sequential elevation (CSE). Two animal studies reported improved cerebral performance category (CPC) scores at 24-hour. The pooled effect on 24-hour survival was not statistically significant (P=0.37). The lone human study reported doubled return of spontaneous circulation (ROSC) (17.9% versus 34.2%, P<0.0001). The pooled effect on ROSC in three porcine studies was OR =3.63 (95% CI: 0.72–18.39). Pooled effects for surrogate physiological outcomes of intracranial cranial pressure (MD −14.08, 95% CI: −23.21 to −4.95, P=0.003), CerPP (MD 14.39, 95% CI: 3.07–25.72, P=0.01) and BBF (MD 0.14, 95% CI: 0.02–0.27, P=0.03), showed statistically significant benefit. Discussion Overall, HU-CPR improved neurologically-intact survival at 24-hour, ROSC and physiological surrogate outcomes in animal models. Despite promising preclinical data, and one human observational study, clinical equipoise remains surrounding the role of HU-CPR in SCA, necessitating clarification with future randomized human trials.

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Reperfusion injury protection during Basic Life Support improves circulation and survival outcomes in a porcine model of prolonged cardiac arrest

Cited by 11 publications

References 31 publications

Head and thorax elevation during active compression decompression cardiopulmonary resuscitation with an impedance threshold device improves cerebral perfusion in a swine model of prolonged cardiac arrest

Head and thorax elevation during active compression decompression cardiopulmonary resuscitation with an impedance threshold device improves cerebral perfusion in a swine model of prolonged cardiac arrest

Efficacy of heads‐up CPR compared to supine CPR positions: Systematic review and meta‐analysis

The role of head-up cardiopulmonary resuscitation in sudden cardiac arrest: a systematic review and meta-analysis

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