Consistent head up cardiopulmonary resuscitation haemodynamics are observed across porcine and human cadaver translational models. (November 2018)

• Record Type: Journal Article
• Authors: Moore, Johanna C.; Holley, Joe; Segal, Nicolas; Lick, Michael C.; Labarère, José; Frascone, Ralph J.; Dodd, Kenneth W.; Robinson, Aaron E.; Lick, Charles; Klein, Lauren; Ashton, Andrew; McArthur, Angela; Tsangaris, Adamantios; Makaretz, Anna; Makaretz, Mike; Debaty, Guillaume; Pepe, Paul E.; Lurie, Keith G.
• Is Part Of: Resuscitation. Volume 132(2018)
• Page Start: 133
• Page End: 139
• Publication Date: 2018-11
• Subjects: Cardiac arrest -- Cardiopulmonary resuscitation -- Impedance threshold device -- Active compression decompression CPR -- Cerebral perfusion -- Swine -- Human cadaver -- Head up CPR; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2018.04.009
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim: The objectives were: 1) replicate key elements of Head Up (HUP) cardiopulmonary resuscitation (CPR) physiology in a traditional swine model of ventricular fibrillation (VF), 2) compare HUP CPR physiology in pig cadavers (PC) to the VF model 3) develop a new human cadaver (HC) CPR model, and 4) assess HUP CPR in HC. Methods: Nine female pigs were intubated, and anesthetized. Venous, arterial, and intracranial access were obtained. After 6 min of VF, CPR was performed for 2 min epochs as follows: Standard (S)-CPR supine (SUP), Active compression decompression (ACD) CPR + impedance threshold device (ITD-16) CPR SUP, then ACD + ITD HUP CPR. The same sequence was performed in PC 3 h later. In 9 HC, similar vascular and intracranial access were obtained and CPR performed for 1 min epochs using the same sequence as above. Results: The mean cerebral perfusion pressure (CerPP, mmHg) was 14.5 ± 6 for ACD + ITD SUP and 28.7 ± 10 for ACD + ITD HUP (p = .007) in VF, −3.6 ± 5 for ACD + ITD SUP and 7.8 ± 9 for ACD + ITD HUP (p = .007) in PC, and 1.3 ± 4 for ACD + ITD SUP and 11.3 ± 5 for ACD + ITD HUP (p = .007) in HC. Mean systolic and diastolic intracranial pressures (ICP) (mmHg) were significantly lower in the ACD + ITD HUP group versus the ACD + ITD SUP group in all three CPR models. Conclusion: HUP CPR decreased ICP while increasing CerPP in pigs in VF as well as in PC and HC CPR models. This first-time demonstration of HUP CPR physiology in humans provides important implications for future resuscitation research and treatment.