Hyun Ho Ryu1, Johanna C Moore2, Demetris Yannopoulos3, Michael Lick4, Scott McKnite5, Sang Do Shin6, Tae Yun Kim7, Anja Metzger8, Jennifer Rees9, Adamantios Tsangaris10, Guillaume Debaty11, Keith G Lurie12. 1. School of Medicine, Chonnam National University, Department of Emergency Medicine, Chonnam National University Hospital. Electronic address: oriryu@naver.com. 2. Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN. Electronic address: Johanna.moore@hcmed.org. 3. Cardiovascular Division, Department of Medicine, University of Minnesota Medical School. Electronic address: yanno001@umn.edu. 4. Minneapolis Medical Research Foundation, Minneapolis, MN. Electronic address: mlick@mmrf.org. 5. Cardiovascular Division, Department of Medicine, University of Minnesota Medical School. Electronic address: Scott047@umn.edu. 6. Department of Emergency Medicine, Seoul National University College of Medicine. Electronic address: shinsangdo@medimail.co.kr. 7. Department of Emergency Medicine, Seoul National University Bundang Hospital. Electronic address: emkty@snubh.org. 8. Zoll Medical Corporation, Minneapolis. Electronic address: ametzger@zoll.com. 9. Cardiovascular Division, Department of Medicine, University of Minnesota Medical School. Electronic address: jrees@umn.edu. 10. Cardiovascular Division, Department of Medicine, University of Minnesota Medical School. Electronic address: atsangar@umn.edu. 11. UJF-Grenoble 1/CNRS/CHU de Grenoble/TIMC-IMAG UMR 5525, Grenoble, France. Electronic address: gdebaty@gmail.com. 12. Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN. Electronic address: keithlurie@icloud.com.
Abstract
AIM: Chest compressions during cardiopulmonary resuscitation (CPR) increase arterial and venous pressures, delivering simultaneous bidirectional high-pressure compression waves to the brain. We hypothesized that this may be detrimental and could be partially overcome by elevation of the head during CPR. MEASUREMENTS: Female Yorkshire farm pigs (n=30) were sedated, intubated, anesthetized, and placed on a table able to elevate the head 30° (15cm) (HUP) and the heart 10° (4cm) or remain in the supine (SUP) flat position during CPR. After 8minutes of untreated ventricular fibrillation and 2minutes of SUP CPR, pigs were randomized to HUP or SUP CPR for 20 more minutes. In Group A, pigs were randomized after 2minutes of flat automated conventional (C) CPR to HUP (n=7) or SUP (n=7) C-CPR. In Group B, pigs were randomized after 2minutes of automated active compression decompression (ACD) CPR plus an impedance threshold device (ITD) SUP CPR to either HUP (n=8) or SUP (n=8). RESULTS: The primary outcome of the study was difference in CerPP (mmHg) between the HUP and SUP positions within groups. After 22minutes of CPR, CerPP was 6±3mmHg in the HUP versus -5±3 in the SUP (p=0.016) in Group A, and 51±8 versus 20±5 (p=0.006) in Group B. Coronary perfusion pressures after 22minutes were HUP 6±2 vs SUP 3±2 (p=0.283) in Group A and HUP 32±5 vs SUP 19±5, (p=0.074) in Group B. In Group B, 6/8 pigs were resuscitated in both positions. No pigs were resuscitated in Group A. CONCLUSIONS: The HUP position in both C-CPR and ACD+ITD CPR significantly improved CerPP. This simple maneuver has the potential to improve neurological outcomes after cardiac arrest.
AIM: Chest compressions during cardiopulmonary resuscitation (CPR) increase arterial and venous pressures, delivering simultaneous bidirectional high-pressure compression waves to the brain. We hypothesized that this may be detrimental and could be partially overcome by elevation of the head during CPR. MEASUREMENTS: Female Yorkshire farm pigs (n=30) were sedated, intubated, anesthetized, and placed on a table able to elevate the head 30° (15cm) (HUP) and the heart 10° (4cm) or remain in the supine (SUP) flat position during CPR. After 8minutes of untreated ventricular fibrillation and 2minutes of SUP CPR, pigs were randomized to HUP or SUP CPR for 20 more minutes. In Group A, pigs were randomized after 2minutes of flat automated conventional (C) CPR to HUP (n=7) or SUP (n=7) C-CPR. In Group B, pigs were randomized after 2minutes of automated active compression decompression (ACD) CPR plus an impedance threshold device (ITD) SUP CPR to either HUP (n=8) or SUP (n=8). RESULTS: The primary outcome of the study was difference in CerPP (mmHg) between the HUP and SUP positions within groups. After 22minutes of CPR, CerPP was 6±3mmHg in the HUP versus -5±3 in the SUP (p=0.016) in Group A, and 51±8 versus 20±5 (p=0.006) in Group B. Coronary perfusion pressures after 22minutes were HUP 6±2 vs SUP 3±2 (p=0.283) in Group A and HUP 32±5 vs SUP 19±5, (p=0.074) in Group B. In Group B, 6/8 pigs were resuscitated in both positions. No pigs were resuscitated in Group A. CONCLUSIONS: The HUP position in both C-CPR and ACD+ITD CPR significantly improved CerPP. This simple maneuver has the potential to improve neurological outcomes after cardiac arrest.
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