Clinical Outcomes and Safety of Passive Leg Raising in Out-of-Hospital Cardiac Arrest. A Randomized Clinical Trial.

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 clinical 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 in survivors and lungs weight from autopsies in non-survivors. Results: In total, 445 randomized CPR attempts were included, 234 were treated with PLR and 211 were controls. Overall, 71.5% were men and the median age was 69 IQR (58-78) years old. At hospital discharge, 4.3% in the PLR group and 4.7% in the control group were alive with CPC 1-2 (OR 0.9; 95% CI 0.4-2.2, p=0.81). A higher survival at hospital admission was found among patients with a shockable rhythm, but there were no significant differences (OR 1.6; 95% CI 0.8-3.4, p=0.18). There were no differences in pulmonary complication rates in chest X-rays (25.9% vs 17.9%, p=0.47) or lung weight 1223 IQR (909.5-1500) mg vs. 1239 IQR (900-1507) mg. 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: Sept 27, 2013, https://clinicaltrials.gov/ct2/show/NCT01952197.