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The Effect of Head Up Cardiopulmonary Resuscitation on Cerebral and Systemic Hemodynamics

      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° (15 cm) (HUP) and the heart 10° (4 cm) or remain in the supine (SUP) flat position during CPR. After 8 minutes of untreated ventricular fibrillation and 2 minutes of SUP CPR, pigs were randomized to HUP or SUP CPR for 20 more minutes. In Group A, pigs were randomized after 2 minutes of flat automated conventional (C) CPR to HUP (n = 7) or SUP (n = 7) C-CPR. In Group B, pigs were randomized after 2 minutes 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 22 minutes of CPR, CerPP was 6 ± 3 mmHg 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 22 minutes 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.

      Keywords

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