Effectiveness and safety of passive leg raise during cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Azeli, Youcef; Bardajı́, Alfredo; Barbería, Eneko; Madrid, Vanesa Lopez; Creixenti, Jordi Baldé; Sender, Laura Fernandez; Bonet, Gil; Rica, Elena; Álvarez, Susana; Axelsson, Christer; Herrera, María Francisca Jiménez

doi:10.1016/j.resuscitation.2020.08.107

Cited by 1 publication

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“…Subsequently, 7 articles were excluded after full-text review. Finally, 6 eligible studies were included in our systematic review and meta-summary [7,8,[14][15][16][17]. The study selection process and reasons for excluding the 7 excluded studies were illustrated in the PRISMA-P 2020 Flow Diagram (Fig.…”

Section: Study Selection and Gradingmentioning

confidence: 99%

“…Of the 6 studies included in the review, Zadini et al [16], Dragoumanos et al [7] and Qvigstad et al [17] were experimental trials involving animal subjects, Holmen et al [14] was an observational study involving human patients, and the remaining 2 were experimental human trials. Among the experimental human trials, Azeli et al [15] was a randomized controlled trial (RCT) and Axelsson et al [8] was a secondary analysis of a cluster trial. A meta-summary of included studies was presented in Tables 1-4 [7,8,[14][15][16][17].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Among the experimental human trials, Azeli et al [15] was a randomized controlled trial (RCT) and Axelsson et al [8] was a secondary analysis of a cluster trial. A meta-summary of included studies was presented in Tables 1-4 [7,8,[14][15][16][17]. Study design of human studies varied greatly.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Cases of non-compliance with the cardiac arrest protocol by the EMS study were then treated as the separate arm of the study. Meanwhile, Azeli et al [15] randomized adult patients with OHCA to either PLR or C-CPR arms. However, details on the study arms and method of randomization were not reported.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…These 3 studies all involved human patients. Meanwhile, only Axelsson et al [8] and Azeli et al [15] reported sufficient data for survival at hospital admission, and only Dragoumanos et al [7] and Azeli et al [15] reported on the outcome of neurologically intact survival. Dragoumanos et al [7] was the sole study that accounted for the outcome of survival to 24 hours.…”

Section: Study Outcomes: Primary and Secondary Outcomesmentioning

confidence: 99%

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The role of passive leg raise during cardiopulmonary resuscitation in sudden cardiac arrest: a systematic review and meta-analysis

et al. 2023

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Passive leg raise (PLR), an experimental cardiopulmonary resuscitation (CPR) technique which involves the elevation of the lower limbs from the horizontal plane during CPR, is thought to improve clinical outcomes in cardiac arrest. By comparing the use of PLR to conventional CPR, we aimed to evaluate survival outcomes and the secondary outcomes of neurologically intact survival and return of spontaneous circulation (ROSC). Methods: In this systematic review, 3 bibliographic databases (PubMed, Embase, and Cochrane Library) were searched for relevant studies from inception to May 1st, 2021. Studies were included if they reported the use of PLR during CPR. Random-effects meta-analysis was performed for the outcome of survival to 30 days. Results:The search yielded 554 articles, of which 6 met criteria for inclusion (3 animal and 3 human studies). The most common implementation of PLR was elevation of the heels corresponding to a 20-to 45-degree elevation at the hips. Two human studies reported higher survival at hospital admission for patients that underwent PLR, though not to the point of statistical significance. Two human studies reported lower ROSC and neurologically intact survival while 2 animal studies reported higher ROSC and neurologically intact survival. The pooled effect on survival to 30 days/survival to hospital discharge was not statistically significantly different (P=0.68), although our analysis showed a trend favouring PLR-CPR. Conclusion: Despite several animal studies showing benefit from PLR-CPR, there is no human data supporting its use in human cardiac arrest. Future research needs to ascertain the best positioning during CPR to optimize clinical outcomes.

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