Tilting for perfusion: Head-up position during cardiopulmonary resuscitation improves brain flow in a porcine model of cardiac arrest

Debaty, Guillaume; Shin, Sang Do; Metzger, Anja; Kim, Taeyun; Ryu, Hyun Ho; Rees, Jennifer; McKnite, Scott; Matsuura, Timothy; Lick, Michael; Yannopoulos, Demetris; Lurie, Keith G.

doi:10.1016/j.resuscitation.2014.11.019

Cited by 62 publications

(67 citation statements)

References 12 publications

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“…The indications for the semirecumbent position during CPR are currently limited to situations with extreme space limitations, although interestingly a recent animal study found that CPR in a head‐up tilt position resulted in improved cerebral blood flow and perfusion pressure compared with a supine position . We used the same wedge to achieve the semi‐recumbent position in the manikin as we used to maintain lateral tilt.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of chest compression feedback during cardiopulmonary resuscitation in lateral tilted and semirecumbent positions: a randomised controlled simulation study

Song

Chee

et al. 2015

Anaesthesia

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SummaryFeedback devices have been shown to improve the quality of chest compression during cardiopulmonary resuscitation for patients in the supine position, but no studies have reported the effects of feedback devices on chest compression when the chest is tilted. Basic life support-trained providers were randomly assigned to administer chest compressions to a manikin in the supine, 30°left lateral tilt and 30°semirecumbent positions, with or without the aid of a feedback device incorporated into a smartphone. Thirty-six participants were studied. The feedback device did not affect the quality of chest compressions in the supine position, but improved aspects of performance in the tilted positions. In the lateral tilted position, the median ( . Female participants applied chest compressions at a more accurate rate using the feedback device in the lateral tilted position but were unable to increase the chest compression depth, whereas male participants were able to increase the force of chest compression using the feedback device in the lateral tilted and semirecumbent positions. We conclude that a feedback device improves the application of chest compressions during simulated cardiopulmonary resuscitation when the chest is tilted.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of chest compression feedback during cardiopulmonary resuscitation in lateral tilted and semirecumbent positions: a randomised controlled simulation study

Song

Chee

et al. 2015

Anaesthesia

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“…Furthermore, during CPR it is sometimes necessary to transport the patient in head-up tilted position such as inside the buildings (climbing the stairs or transport in space-restricted elevators). At present, it is not known how harmful such tilting is or conversely, whether it can be beneficial as recently suggested by Debaty et al (2015).…”

Section: Introductionmentioning

confidence: 96%

Head-Up Tilt Rapidly Compromises Hemodynamics in Healthy Anesthetized Swine

Mlček

Bělohlávek²,

Huptych³

et al. 2015

Physiol Res

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The aims were to explore the effect of head-up tilt (HUT) to 30 and 60 degrees on hemodynamics and tissue oxygenation in anesthetized healthy swine. The data serve as a reference for a study of resuscitation efficacy at HUT such as during transport. Nine healthy swine (49±4 kg) were anesthetized and multiple sensors including myocardial pressure-volume loops catheter, carotid flow probe, blood pressure catheters, near infrared spectroscopy (NIRS) tissue oximetry and mixed venous oximetry (SVO2) catheter were introduced and parameters continuously recorded. Experimental protocol consisted of baseline in supine position (15 min), 30 degrees HUT (15 min), recovery at supine position (15 min) and 60 degrees HUT (5 min). Vacuum mattress was used for body fixation during tilts. We found that 30 and 60 degrees inclination led to significant immediate reduction in hemodynamic and oximetry parameters. Mean arterial pressure (mm Hg) decreased from 98 at baseline to 53 and 39, respectively. Carotid blood flow dropped to 47 % and 22 % of baseline values, end diastolic volume to 49 % and 53 % and stroke volume to 47 % and 45 % of baseline. SVO2 and tissue oximetry decreased by 17 and 21 percentage points. The values are means. In conclusions, within minutes, both 30 and 60 degrees head-up tilting is poorly tolerated in anesthetized swine. Significant differences among individual animals exist.

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“…These low CerPP values are generally incompatible with life. 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].…”

mentioning

confidence: 93%

“…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].…”

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confidence: 99%

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

et al. 2018

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Tilting for perfusion: Head-up position during cardiopulmonary resuscitation improves brain flow in a porcine model of cardiac arrest

Cited by 62 publications

References 12 publications

Effectiveness of chest compression feedback during cardiopulmonary resuscitation in lateral tilted and semirecumbent positions: a randomised controlled simulation study

Effectiveness of chest compression feedback during cardiopulmonary resuscitation in lateral tilted and semirecumbent positions: a randomised controlled simulation study

Head-Up Tilt Rapidly Compromises Hemodynamics in Healthy Anesthetized Swine

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

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