Youcef Azeli1,2,3, Alfredo Bardají4,5,6, Eneko Barbería6,7, Vanesa Lopez-Madrid8, Jordi Bladé-Creixenti9, Laura Fernández-Sender10, Gil Bonet5, Elena Rica11, Susana Álvarez11, Alberto Fernández12, Christer Axelsson13, Maria F Jiménez-Herrera14. 1. Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain. youcefazeli@gencat.cat. 2. Emergency Department, Sant Joan University Hospital, Reus, Spain. youcefazeli@gencat.cat. 3. Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain. youcefazeli@gencat.cat. 4. Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain. 5. Cardiology Department, Joan XXIII, University Hospital, Tarragona, Spain. 6. Universitat Rovira i Virgili, Tarragona, Spain. 7. Pathology Service, Institute of Legal Medicine and Forensic Sciences of Catalonia, Tarragona, Spain. 8. Emergency Department, Sant Joan University Hospital, Reus, Spain. 9. Atenció Primaria, Institut Català de la Salut, Tarragona, Spain. 10. Llevant Clinic Unit, Santa Tecla Hospital, Tarragona, Spain. 11. Department de Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain. 12. Departament d'Enginyeria Química, Universitat Rovira i Virgili, Tarragona, Spain. 13. Center of Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden. 14. Department of Nursing, Universitat Rovira i Virgili, Tarragona, Spain.
Abstract
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 .
RCT Entities:
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 .
Authors: Jan-Thorsten Gräsner; Rolf Lefering; Rudolph W Koster; Siobhán Masterson; Bernd W Böttiger; Johan Herlitz; Jan Wnent; Ingvild B M Tjelmeland; Fernando Rosell Ortiz; Holger Maurer; Michael Baubin; Pierre Mols; Irzal Hadžibegović; Marios Ioannides; Roman Škulec; Mads Wissenberg; Ari Salo; Hervé Hubert; Nikolaos I Nikolaou; Gerda Lóczi; Hildigunnur Svavarsdóttir; Federico Semeraro; Peter J Wright; Carlo Clarens; Ruud Pijls; Grzegorz Cebula; Vitor Gouveia Correia; Diana Cimpoesu; Violetta Raffay; Stefan Trenkler; Andrej Markota; Anneli Strömsöe; Roman Burkart; Gavin D Perkins; Leo L Bossaert Journal: Resuscitation Date: 2016-06-16 Impact factor: 5.262
Authors: Jason E Buick; Ian R Drennan; Damon C Scales; Steven C Brooks; Adams Byers; Sheldon Cheskes; Katie N Dainty; Michael Feldman; P Richard Verbeek; Cathy Zhan; Alex Kiss; Laurie J Morrison; Steve Lin Journal: Circ Cardiovasc Qual Outcomes Date: 2018-01
Authors: Demetris Yannopoulos; Scott McKnite; Tom P Aufderheide; Gardar Sigurdsson; Ronald G Pirrallo; David Benditt; Keith G Lurie Journal: Resuscitation Date: 2005-03 Impact factor: 5.262