The Effect of Head Up Cardiopulmonary Resuscitation on Cerebral and Systemic Hemodynamics

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

“…It is therefore not surprising that Putzer et al did not find improved cerebral NIRS readings or cerebral metabolism with HUP CPR. These low CerPP values are consistent with previous work comparing SUP and HUP with standard CPR only [3].…”

“…CPR adjuncts to improve hemodynamics such as the Impedance Threshold Device (ITD) and Active Compression-Decompression (ACD) CPR were not used, different from prior published HUP CPR studies [2][3][4]. The hemodynamics observed by Putzer et al were markedly lower than HUP CPR studies performed previously with these circulatory enhancement devices, where CerPP was observed up to 50-60% of baseline with HUP ACD + ITD CPR [3,4]. It is therefore not surprising that Putzer et al did not find improved cerebral NIRS readings or cerebral metabolism with HUP CPR.…”

“…This is a fundamental requirement of HUP CPR. Using the ITD alone or ACD + ITD CPR, HUP CPR in swine has been shown to (1) Reduce intracranial pressure, (2) Reduce the potential for a concussion with every compression, and (3) Increase cerebral and to a lesser degree coronary perfusion pressures, (4) Effectively double cerebral blood flow [2][3][4].…”

Personalized physiology-guided resuscitation in highly monitored patients with cardiac arrest—the PERSEUS resuscitation protocol

“…This may be facilitated with the use of Head Up CPR (HUP-CPR), which uses gravity to enhance venous return from the head and paravertebral plexus, further reducing ICP and increasing CerPP [46]. In a swine study, CerPP remained significantly higher in the HUP-CPR pigs, especially when an impedance threshold device was used [47]. These physiological changes were recently replicated in deceased human cadaver models; HUP-CPR resulted in decreased ICP and increased CerPP, further supporting its use in patients in cardiac arrest [48].…”

Mechanische Thoraxkompressionsgeräte

“…Durch die externe Thoraxkompression wird ein Minimalkreislauf generiert, der jedoch nur ca. 15-30 % der Ausgangswerte des zerebralen und kardialen Blutflusses erreicht [6]. Daher ist die kontinuierliche, möglichst ununterbrochene Durchführung der Herzdruckmassage (HDM) gemäß den ERC-Empfehlungen von 2015 für erwachsene Patienten essenziell für ein gutes Behandlungsergebnis [3][4][5].…”