The effect of resuscitation position on cerebral and coronary perfusion pressure during mechanical cardiopulmonary resuscitation in porcine cardiac arrest model

Head and thorax elevation during active compression decompression cardiopulmonary resuscitation with an impedance threshold device improves cerebral perfusion in a swine model of prolonged cardiac arrest

“…The head up (HUP) position during cardiopulmonary resuscitation (CPR), either with a whole body tilt, or elevation of just the head and thorax, has been described as a novel approach to increase cerebral perfusion pressure when compared with CPR in the supine position (SUP) in swine models of cardiac arrest. [1][2][3][4] Additionally, higher cerebral blood flow has been described with the head up whole body tilt versus whole body flat after 5 minutes of mechanical CPR with an impedance threshold device (ITD). 1 However, most clinical CPR efforts last a minimum of 15-20 minutes.…”

Does ‘heads-up’ cardiopulmonary resuscitation improve outcomes for patients in out-of-hospital cardiac arrest? A systematic review

“…Consistently, as displayed in Table 1, ICP has been documented to decrease with elevating the patient, whether by a full body tilt or by elevating the head and thorax (Ryu et al, 2016). The ideal angle of elevation was shown to be 30 o (Kim et al, 2017). Therefore ACD+ITD HUPCPR has the potential to improve patient outcomes given its documented ability to reduce ICP in the porcine model of cardiac arrest.…”

“…This extreme heterogeneity and variance from standard treatment make it difficult to determine even at what stage initiation of HUPCPR would be most beneficial, if at all. Additionally, Kim et al (2017) displayed ROSC for all subjects involved in their study, each of which experienced HUT, SUP and HDT positioning.…”

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

“…Other lessons learned include that CPR should be started in the SUP position before elevation of the head to 'prime' the cardio-cerebral circuit, as the optimal head and heart elevation height or angle is likely dependent upon the amount of forward blood flow. Rapid elevation of the head to the HUP position may be dangerous as the aortic pressure can decline due to gravity [5]. Thus, CPR should not be interrupted when the head is elevated.…”

“…Thus, CPR should not be interrupted when the head is elevated. Additionally, a whole-body HUP position over the long term may be dangerous as blood eventually flows to the feet due to gravity over time [1,2,5].…”