Effects of head-up vs. supine CPR on cerebral oxygenation and cerebral metabolism – a prospective, randomized porcine study

Putzer, Gabriel; Braun, Patrick; Martini, Judith; Niederstätter, Ines; Abram, Julia; Lindner, Andrea Katharina; Neururer, Sabrina; Mulino, Miriam; Glodny, Bernhard; Helbok, Raimund; Mair, Peter

doi:10.1016/j.resuscitation.2018.04.038

Cited by 43 publications

(48 citation statements)

References 23 publications

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“…There remain several caveats regarding the safety of the head-up approach. Our own laboratory work, and that of others, have led us to believe that the head-up process should only begin after several minutes of providing traditional supine CPR with the ITD applied to help “prime the pump” (28, 29). It is further recommended that tilting should be implemented gradually, in a specific sequence following the “priming” step, and only with concurrent use of an ITD in particular (28–31).…”

Section: Discussionmentioning

confidence: 99%

Confirming the Clinical Safety and Feasibility of a Bundled Methodology to Improve Cardiopulmonary Resuscitation Involving a Head-Up/Torso-Up Chest Compression Technique

Pepe

Scheppke

Antevy

et al. 2019

Critical Care Medicine

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Objectives: Combined with devices that enhance venous return out of the brain and into the thorax, preclinical outcomes are improved significantly using a synergistic bundled approach involving mild elevation of the head and chest during cardiopulmonary resuscitation. The objective here was to confirm clinical safety/feasibility of this bundled approach including use of mechanical cardiopulmonary resuscitation provided at a head-up angle. Design: Quarterly tracking of the frequency of successful resuscitation before, during, and after the clinical introduction of a bundled head-up/torso-up cardiopulmonary resuscitation strategy. Setting: 9-1-1 response system for a culturally diverse, geographically expansive, populous jurisdiction. Patients: All 2,322 consecutive out-of-hospital cardiac arrest cases (all presenting cardiac rhythms) were followed over 3.5 years (January 1, 2014, to June 30, 2017). Interventions: In 2014, 9-1-1 crews used LUCAS (Physio-Control Corporation, Redmond, WA) mechanical cardiopulmonary resuscitation and impedance threshold devices for out-of-hospital cardiac arrest. After April 2015, they also 1) applied oxygen but deferred positive pressure ventilation several minutes, 2) solidified a pit-crew approach for rapid LUCAS placement, and 3) subsequently placed the patient in a reverse Trendelenburg position (~20°). Measurements and Main Results: No problems were observed with head-up/torso-up positioning ( n = 1,489), but resuscitation rates rose significantly during the transition period (April to June 2015) with an ensuing sustained doubling of those rates over the next 2 years (mean, 34.22%; range, 29.76–39.42%; n = 1,356 vs 17.87%; range, 14.81–20.13%, for 806 patients treated prior to the transition; p < 0.0001). Outcomes improved across all subgroups. Response intervals, clinical presentations and indications for attempting resuscitation remained unchanged. Resuscitation rates in 2015–2017 remained proportional to neurologically intact survival (~35–40%) wherever tracked. Conclusions: The head-up/torso-up cardiopulmonary resuscitation bundle was feasible and associated with an immediate, steady rise in resuscitation rates during implementation followed by a sustained doubling of the number of out-of-hospital cardiac arrest patients being resuscitated. These findings make a compelling case that this bundled technique will improve out-of-hospital cardiac arrest outcomes significantly in other clinical evaluations.

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Section: Discussionmentioning

confidence: 99%

Confirming the Clinical Safety and Feasibility of a Bundled Methodology to Improve Cardiopulmonary Resuscitation Involving a Head-Up/Torso-Up Chest Compression Technique

Pepe

Scheppke

Antevy

et al. 2019

Critical Care Medicine

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“…1 Among other measurement techniques, our model includes measurement of haemoglobin oxygen saturation in cerebral venous blood (S cv O 2 ) collected from a catheter in the transverse sinus. 2,3 Nordström et al claim that cerebral venous blood in pigs does not drain via the internal jugular vein (IJV) and question the placement of an angiographic catheter via the IJV into the transverse sinus. They refer to two small imaging studies in three pigs each.…”

Section: To the Editormentioning

confidence: 99%

“Reply to: Cerebral venous blood is not drained via the internal jugular vein in the pig”

et al. 2021

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“…This anesthetic regime has been proven to guarantee appropriate depth of anesthesia without hemodynamic disturbances [8].…”

Section: Animal Preparationmentioning

confidence: 99%

Individualized flow-controlled ventilation compared to best clinical practice pressure-controlled ventilation: a prospective randomized porcine study.

Spraider

Martini

Abram

et al. 2020

Preprint

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Background: Flow-controlled ventilation is a novel ventilation method which allows to individualize ventilation according to dynamic lung mechanic limits based on direct tracheal pressure measurement at a stable constant gas flow during inspiration and expiration. The aim of this porcine study was to compare individualized flow-controlled ventilation (FCV) and current guideline-conform pressure-controlled ventilation (PCV) in long-term ventilation.Methods: Anesthetized pigs were ventilated with either FCV or PCV over a period of ten hours with a fixed FiO2 of 0.3. FCV settings were individualized by compliance-guided positive end-expiratory pressure (PEEP) and peak pressure (Ppeak) titration. Flow was adjusted to maintain normocapnia and the inspiration to expiration ratio (I:E ratio) was set at 1:1. PCV was performed with a PEEP of 5 cm H2O and Ppeak was set to achieve a tidal volume (VT) of 7 ml/kg. The respiratory rate was adjusted to maintain normocapnia and the I:E ratio was set at 1:1.5. Repeated measurements during observation period were assessed by linear mixed-effects model.Results: In FCV (n=6) respiratory minute volume was significantly reduced (6.0 vs 12.7, MD -6.8 (-8.2 to -5.4) l/min; p<0.001) as compared to PCV (n=6). Oxygenation was improved in the FCV group (paO2 119.8 vs 96.6, MD 23.2 (9.0 to 37.5) torr; 15.97 vs 12.87, MD 3.10 (1.19 to 5.00) kPa; p=0.010) and CO2 removal was more efficient (paCO2 40.1 vs 44.9, MD -4.7 (-7.4 to -2.0) torr; 5.35 vs 5.98, MD -0.63 (-0.99 to -0.27) kPa; p=0.006). Ppeak and driving pressure were comparable in both groups, whereas PEEP was significantly lower in FCV (p=0.002). Computed tomography revealed a significant reduction in non-aerated lung tissue in individualized FCV (p=0.026) and no significant difference in overdistended lung tissue, although a significantly higher VT was applied (8.2 vs 7.6, MD 0.7 (0.2 to 1.2) ml/kg; p=0.025).Conclusion: Our long-term ventilation study demonstrates the applicability of a compliance-guided individualization of FCV settings, which resulted in significantly improved gas exchange and lung tissue aeration without signs of overinflation as compared to best clinical practice PCV.

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Effects of head-up vs. supine CPR on cerebral oxygenation and cerebral metabolism – a prospective, randomized porcine study

Cited by 43 publications

References 23 publications

Confirming the Clinical Safety and Feasibility of a Bundled Methodology to Improve Cardiopulmonary Resuscitation Involving a Head-Up/Torso-Up Chest Compression Technique

Confirming the Clinical Safety and Feasibility of a Bundled Methodology to Improve Cardiopulmonary Resuscitation Involving a Head-Up/Torso-Up Chest Compression Technique

“Reply to: Cerebral venous blood is not drained via the internal jugular vein in the pig”

Individualized flow-controlled ventilation compared to best clinical practice pressure-controlled ventilation: a prospective randomized porcine study.

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