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

Abstract

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.

A Pilot Study to Examine the Effect of Passive Straight Leg Raise Performed During Cardiopulmonary Resuscitation on Cerebral Perfusion Measured by Noninvasive Cerebral Oximetry

“…Use of PLR has been shown to improve coronary perfusion pressure in an animal model ( 8 ) and improve cardiac output, coronary perfusion pressure, and systemic perfusion pressure in computation models ( 9 , 10 ). However, there is lack of human data supporting its use in cardiac arrest ( 11 , 12 ).…”