The “do’s and don’ts” of head up CPR: Lessons learned from the animal laboratory

Moore, Johanna C.; Segal, Nicolas; Debaty, Guillaume; Lurie, Keith G.

doi:10.1016/j.resuscitation.2018.05.023

Cited by 8 publications

(8 citation statements)

References 5 publications

(12 reference statements)

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“…Another important stipulation is that the AHUP-CPR strategy must be implemented rapidly with proper sequencing, timing, and tools (43, 51). Similar to automated external defibrillators, faster use improves survival, yet with a wider lifesaving window for both shockable and NS presentations (5, 13, 14, 22, 43, 51).…”

Section: Discussionmentioning

confidence: 99%

Survival for Nonshockable Cardiac Arrests Treated With Noninvasive Circulatory Adjuncts and Head/Thorax Elevation*

Bachista,

Moore,

Labarère

et al. 2024

Critical Care Medicine

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OBJECTIVES: Cardiac arrests remain a leading cause of death worldwide. Most patients have nonshockable electrocardiographic presentations (asystole/pulseless electrical activity). Despite well-performed basic and advanced cardiopulmonary resuscitation (CPR) interventions, patients with these presentations have always faced unlikely chances of survival. The primary objective was to determine if, in addition to conventional CPR (C-CPR), expeditious application of noninvasive circulation-enhancing adjuncts, and then gradual elevation of head and thorax, would be associated with higher likelihoods of survival following out-of-hospital cardiac arrest (OHCA) with nonshockable presentations. DESIGN: Using a prospective observational study design (ClinicalTrials.gov NCT05588024), patient data from the national registry of emergency medical services (EMS) agencies deploying the CPR-enhancing adjuncts and automated head/thorax-up positioning (AHUP-CPR) were compared with counterpart reference control patient data derived from the two National Institutes of Health clinical trials that closely monitored quality CPR performance. Beyond unadjusted comparisons, propensity score matching and matching of time to EMS-initiated CPR (TCPR) were used to assemble cohorts with corresponding best-fit distributions of the well-established characteristics associated with OHCA outcomes. SETTING: North American 9-1-1 EMS agencies. PATIENTS: Adult nontraumatic OHCA patients receiving 9-1-1 responses. INTERVENTIONS: In addition to C-CPR, study patients received the CPR adjuncts and AHUP (all U.S. Food and Drug Administration-cleared). MEASUREMENTS AND MAIN RESULTS: The median TCPR for both AHUP-CPR and C-CPR groups was 8 minutes. Median time to AHUP initiation was 11 minutes. Combining all patients irrespective of lengthier response intervals, the collective unadjusted likelihood of AHUP-CPR group survival to hospital discharge was 7.4% (28/380) vs. 3.1% (58/1,852) for C-CPR (odds ratio [OR], 2.46 [95% CI, 1.55–3.92]) and, after propensity score matching, 7.6% (27/353) vs. 2.8% (10/353) (OR, 2.84 [95% CI, 1.35–5.96]). Faster AHUP-CPR application markedly amplified odds of survival and neurologically favorable survival. CONCLUSIONS: These findings indicate that, compared with C-CPR, there are strong associations between rapid AHUP-CPR treatment and greater likelihood of patient survival, as well as survival with good neurological function, in cases of nonshockable OHCA.

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Section: Discussionmentioning

confidence: 99%

Survival for Nonshockable Cardiac Arrests Treated With Noninvasive Circulatory Adjuncts and Head/Thorax Elevation*

Bachista,

Moore,

Labarère

et al. 2024

Critical Care Medicine

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“…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). The main admonition is to avoid going directly to the full-tilt target at the beginning of resuscitation efforts and to use appropriate accompanying adjuncts to enhance circulation as described in this analysis considering that it otherwise may even be harmful hemodynamically (28–31).…”

Section: Discussionmentioning

confidence: 99%

“…2). Subsequent work in our laboratory has indicated preliminarily that supine (0°) position for the legs accompanied by a head-up and torso-up position may be the more ideal approach (12, 14, 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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“…3,7,8 With C-CPR, CerPP values of less than 10% of pre-arrest values were observed after nearly 20 minutes. 3,[7][8][9] C-CPR could not provide enough forward and upward flow. Improved 24 hour neurological survival was shown in animals receiving ACD+ITD CPR, with an initial 2 minute priming period and HUP CPR with 2 minute gradual elevation, versus C-CPR flat.…”

Section: Introductionmentioning

confidence: 98%

“…Based on animal [2][3][4][5][6]8,9 and human cadaver studies, 11 an automated (A) HUP device capable of controlled elevation of the head and thorax over 2 minutes was developed. The FDA cleared the device for use during CPR in 2019 as a 510K-cleared patient positioning device.…”

Section: Introductionmentioning

confidence: 99%

Faster time to automated elevation of the head and thorax during cardiopulmonary resuscitation increases the probability of return of spontaneous circulation

et al. 2022

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The “do’s and don’ts” of head up CPR: Lessons learned from the animal laboratory

Abstract: Resuscitation 129 (2018) e6-e7 0300-9572/

Cited by 8 publications

References 5 publications

Survival for Nonshockable Cardiac Arrests Treated With Noninvasive Circulatory Adjuncts and Head/Thorax Elevation*

Survival for Nonshockable Cardiac Arrests Treated With Noninvasive Circulatory Adjuncts and Head/Thorax Elevation*

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

Faster time to automated elevation of the head and thorax during cardiopulmonary resuscitation increases the probability of return of spontaneous circulation

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