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. (December 2017)

• Record Type: Journal Article
• Authors: Moore, Johanna C.; Segal, Nicolas; Lick, Michael C.; Dodd, Kenneth W.; Salverda, Bayert J.; Hinke, Mason B.; Robinson, Aaron E.; Debaty, Guillaume; Lurie, Keith G.
• Is Part Of: Resuscitation. Volume 121(2017)
• Page Start: 195
• Page End: 200
• Publication Date: 2017-12
• Subjects: Active compression decompression CPR -- Cardiac arrest -- Cardiopulmonary resuscitation -- Cerebral perfusion -- Impedance threshold device -- Head and thorax elevation -- Head up CPR -- Mechanical CPR -- Resuscitation; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2017.07.033
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim of the study: As most cardiopulmonary resuscitation (CPR) efforts last longer than 15 min, the aim of this study was to compare brain blood flow between the Head Up (HUP) and supine (SUP) body positions during a prolonged CPR effort of 15 min, using active compression-decompression (ACD) CPR and impedance threshold device (ITD) in a swine model of cardiac arrest. Methods: Ventricular fibrillation (VF) was induced in anesthetized pigs. After 8 min of untreated VF followed by 2 min of ACD-CPR + ITD in the SUP position, pigs were randomized to 18 min of continuous ACD-CPR + ITD in either a 30° HUP or SUP position. Microspheres were injected before VF and then 5 and 15 min after start of CPR. Results: The mean blood flow (ml/min/g, mean ± SD) to the brain after 15 min of CPR was 0.42 ± 0.05 in the HUP group (n = 8) and 0.21 ± 0.04 SUP (n = 10), respectively, (p < 0.01). The HUP group also had statistically significantly lower intracranial pressures and higher calculated cerebral perfusion pressures after 5, 15, 19 (before adrenaline) and 20 (after adrenaline) minutes of HUT versus SUP CPR. Conclusions: After prolonged ACD-CPR + ITD in the HUP position, brain blood flow was 2-fold higher versus the SUP position. These positive findings provide strong pre-clinical support to proceed with a clinical evaluation of elevation of the head and thorax during ACD-CPR + ITD in humans in cardiac arrest.