scholarly journals The effect of the head-up position on cardiopulmonary resuscitation: a systematic review and meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Cheng-Chieh Huang ◽  
Kuan-Chih Chen ◽  
Zih-Yang Lin ◽  
Yu-Hsuan Chou ◽  
Wen-Liang Chen ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Perfusion Pressure ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Coronary Perfusion Pressure ◽  
Spontaneous Circulation ◽  
Experimental Models ◽  
Cochrane Library ◽  
Coronary Perfusion ◽  
Improved Outcomes

Abstract Objective Experimental studies of head-up positioning (HUP) during cardiopulmonary resuscitation (CPR) have had some degree of conflicting published results. The current study aim was to analyze and reconcile those discrepancies in order to better clarify the effects of HUP CPR compared to conventional supine (SUP) CPR. Methods Three databases (PubMed, EMBASE and Cochrane Library) were searched comprehensively (from each respective database's inception to May 2021) for articles addressing HUP CPR. The primary outcome to be observed was cerebral perfusion pressure (CerPP), and secondary outcomes were mean intracranial pressure (ICP), mean arterial pressure (MAP), coronary perfusion pressure (CoPP) and frequencies of return of spontaneous circulation (ROSC). Results Seven key studies involving 131 animals were included for analysis. Compared to SUP CPR, CerPP (MD 10.37; 95% CI 7.11–13.64; p < 0.01; I2 = 58%) and CoPP (MD 7.56; 95% CI 1.84–13.27, p = 0.01; I2 = 75%) increased significantly with HUP CPR, while ICP (MD − 13.66; 95% CI − 18.6 to –8.71; p < 0.01; I2 = 96%) decreased significantly. Combining all study methodologies, there were no significant differences detected in MAP (MD − 1.63; 95% CI − 10.77–7.52; p = 0.73; I2 = 93%) or frequency of ROSC (RR 0.9; 95% CI 0.31–2.60; p = 0.84; I2 = 65%). However, in contrast to worse outcomes in studies using immediate elevation of the head in a reverse Trendelenburg position, study outcomes were significantly improved when HUP (head and chest only) was introduced in a steady, graduated manner following a brief period of basic CPR augmented by active compression–decompression (ACD) and impedance threshold (ITD) devices. Conclusion In experimental models, gradually elevating the head and chest following a brief interval of circulatory priming with ACD and ITD devices can enhance CoPP, lower ICP and improve CerPP significantly while maintaining MAP. This effect is immediate, remains sustained and is associated with improved outcomes.

scholarly journals The effect of the head-up position in cardiopulmonary resuscitation – A systematic review and meta-analysis

2021 ◽  
Author(s):  
Cheng-Chieh Huang ◽  
Kuan-Chih Chen ◽  
Zih-Yang Lin ◽  
Yu-Hsuan Chou ◽  
Wen-Liang Chen ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Perfusion Pressure ◽  
Meta Analysis ◽  
Spontaneous Circulation ◽  
Cochrane Library ◽  
Pros And Cons ◽  
The Difference ◽  
The Cochrane Library ◽  
Acd Cpr ◽  
Impedance Threshold Device

Abstract ObjectiveThe pros and cons of the head-up position (HUP) in cardiopulmonary resuscitation (CPR) have been controversial in previous studies. This study aims to clarify the effect of HUP CPR compared to supine position (SUP) CPR.MethodThree databases were comprehensively searched (PubMed, EMBASE and the Cochrane Library) for articles published from database inception to 10 May 2021. The primary outcome was cerebral perfusion pressure (CerPP). The secondary outcomes were mean intracranial pressure (ICP), mean artery pressure (MAP), coronary artery perfusion pressure (CoPP) and the return of spontaneous circulation (ROSC) rate.ResultA total of 7 studies including 138 animals were included. We found that CerPP (SMD, 1.58; 95% CI, 0.98–2.19; p < 0.01; I2 = 51%) and ICP (SMD, -3.59; 95% CI, -5.16– -2.02; p < 0.01; I2 = 87%) were decreased significantly in the HUP group. HUP had a similar MAP (SMD, -0.54; 95% CI, -1.75–0.66; p = 0.38; I2 = 87%) and ROSC rate (RR, 0.9; 95% CI, 0.31–2.60; p = 0.84; I2 = 65%) to SUP. In addition, there was an increased CoPP trend in HUP, but the difference was not statistically significant (SMD, 0.92; 95% CI, -0.24–2.08; p = 0.12; I2 = 84%)ConclusionThe HUP 30° in active compression-decompression CPR (ACD-CPR) with an impedance threshold device (ITD) can increase CerPP by significantly lowering ICP and maintaining MAP compared to SUP, and the effect is immediate and lasts the whole CPR duration. In addition, CoPP might also be increased compared to that with SUP.

Endobronchial Vasopressin Improves Survival during Cardiopulmonary Resuscitation in Pigs 

1997 ◽  
Vol 86 (6) ◽  
pp. 1375-1381 ◽  
Author(s):  
Volker Wenzel ◽  
Karl H. Lindner ◽  
Andreas W. Prengel ◽  
Keith G. Lurie ◽  
Hans U. Strohmenger
Keyword(s):  
Placebo Group ◽  
Cardiopulmonary Resuscitation ◽  
Drug Administration ◽  
Porcine Model ◽  
Perfusion Pressure ◽  
Coronary Perfusion Pressure ◽  
Spontaneous Circulation ◽  
Coronary Perfusion ◽  
Successful Resuscitation ◽  
Short Period

Background Intravenous administration of vasopressin during cardiopulmonary resuscitation (CPR) has been shown to be more effective than optimal doses of epinephrine. This study evaluated the effect of endobronchial vasopressin during CPR. Methods After 4 min of untreated ventricular fibrillation and 3 min of CPR, 21 pigs were randomized to be treated with 0.8 U/kg intravenous vasopressin (n = 7), 0.8 U/kg endobronchial vasopressin (n = 9), or an endobronchial placebo of normal saline (n = 5). Defibrillation was performed 5 min after drug administration to attempt return of spontaneous circulation. Results All animals in the intravenous and endobronchial vasopressin group were resuscitated successfully, but only two of five animals in the placebo group were. At 2 and 5 min after drug administration, coronary perfusion pressure in the intravenous and endobronchial vasopressin group was significantly higher than in the placebo group (50 +/- 10, 34 +/- 5 vs. 16 +/- 6 mmHg, respectively; and 35 +/- 10, 39 +/- 10 vs. 19 +/- 5 mmHg, respectively; P &lt; 0.05). Conclusions Endobronchial vasopressin is absorbed during CPR, coronary perfusion pressure is increased significantly within a short period, and the chance of successful resuscitation is increased in this porcine model of CPR. Endobronchial vasopressin may be an alternative for vasopressor administration during CPR, when intravenous access is delayed or not available.

Milrinone Combined with Vasopressin Improves Cardiac Index after Cardiopulmonary Resuscitation in a Pig Model of Myocardial Infarction

2007 ◽  
Vol 106 (1) ◽  
pp. 100-106 ◽  
Author(s):  
Thomas Palmaers ◽  
Sven Albrecht ◽  
Fabian Heuser ◽  
Christian Leuthold ◽  
Juergen Schuettler ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Cardiopulmonary Resuscitation ◽  
Cardiac Index ◽  
Arterial Pressure ◽  
Perfusion Pressure ◽  
Coronary Perfusion Pressure ◽  
Spontaneous Circulation ◽  
Cardiac Insufficiency ◽  
Coronary Perfusion ◽  
Return Of Spontaneous Circulation

Background Milrinone used for acute cardiac insufficiency could be of interest during cardiopulmonary resuscitation because of its positive inotropic effects. In this study, the combination of milrinone-vasopressin was compared with epinephrine and vasopressin, as well as with the combination of epinephrine-vasopressin, in reference to hemodynamics. Methods Thirty-two pigs underwent ligation of the circumflex coronary artery and induction of ventricular fibrillation lasting for 4 min. Cardiopulmonary resuscitation was performed after randomization to one of four groups: epinephrine (30-microg/kg bolus), vasopressin (0.4-U/kg bolus), epinephrine-vasopressin (15-microg/kg epinephrine bolus, 0.2-U/kg vasopressin bolus), or milrinone-vasopressin (0.4-U/kg vasopressin bolus, 50-microg/kg milrinone bolus over 5 min and a continuous infusion of 0.4 microg.kg.min). The hemodynamic variables were measured before cardiopulmonary resuscitation as well as 4, 8, 15, and 30 min after return of spontaneous circulation. Results All animals were resuscitated successfully. The animals of the milrinone-vasopressin group displayed significantly (P&lt;0.05) higher cardiac index values (30 min after return of spontaneous circulation: epinephrine, 65.8+/-13.2; vasopressin, 70.7+/-18.3; epinephrine-vasopressin, 69.1+/-36.2; milrinone-vasopressin, 120.7+/-34.8 ml.min.kg) without a decrease in mean arterial pressure or coronary perfusion pressure. Conclusions The combination of vasopressin-milrinone as compared with epinephrine during cardiopulmonary resuscitation leads to an improved cardiac index without relevant decrease of mean arterial pressure or coronary perfusion pressure.

scholarly journals Swine model in cardiopulmonary resuscitation research

2017 ◽  
Vol 60 (3) ◽  
pp. 254
Author(s):  
Th. XANTHOS (Θ. ΞΑΝΘΟΣ)
Keyword(s):  
Cardiac Arrest ◽  
Perfusion Pressure ◽  
Coronary Perfusion Pressure ◽  
Spontaneous Circulation ◽  
Experimental Models ◽  
Medical Emergency ◽  
Swine Model ◽  
Coronary Perfusion ◽  
Anatomy And Physiology ◽  
Experimental Treatments

Cardiac Arrest (CA) constitutes a real medical emergency. Various experimental models have been developed in order to test experimental treatments. Animal models that have been used in CA research are rodents, rabbits, cats and dogs, primates and swine. Among these, swine are used more often. The reason behind this choice is mostly its close resemblance to the human cardiac anatomy and physiology. Various haemodynamic variables have been investigated as predictors of the return of spontaneous circulation (ROSC). Coronary Perfusion Pressure (CPP) is the only proven predictor for ROSC. CPP, which is responsible for myocardial perfusion, greatly augments during chest compressions. ROSC and therefore survival after CA has been associated with CCP values greater than 15 mmHg for humans and 25 mmHg for animals. For the experimental induction of CA various electric sources have been used. All these experimental devices could be potentially dangerous for researchers, even though, no incidence of electrocution has been reported in the international literature. The ordinary cadmium battery appears to be safer and is an extremely effective way of inducing cardiac arrest.

scholarly journals Cardiac arrest complicating cardiogenic shock: from pathophysiological insights to Impella-assisted cardiopulmonary resuscitation in a pheochromocytoma-induced Takotsubo cardiomyopathy—a case report

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Filippo Zilio ◽  
Simone Muraglia ◽  
Roberto Bonmassari
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Left Ventricle ◽  
Cardiogenic Shock ◽  
Takotsubo Cardiomyopathy ◽  
Perfusion Pressure ◽  
Coronary Perfusion Pressure ◽  
Left Ventricular ◽  
Coronary Perfusion ◽  
Refractory Cardiac Arrest

Abstract Background A ‘catecholamine storm’ in a case of pheochromocytoma can lead to a transient left ventricular dysfunction similar to Takotsubo cardiomyopathy. A cardiogenic shock can thus develop, with high left ventricular end-diastolic pressure and a reduction in coronary perfusion pressure. This scenario can ultimately lead to a cardiac arrest, in which unloading the left ventricle with a peripheral left ventricular assist device (Impella®) could help in achieving the return of spontaneous circulation (ROSC). Case summary A patient affected by Takotsubo cardiomyopathy caused by a pheochromocytoma presented with cardiogenic shock that finally evolved into refractory cardiac arrest. Cardiopulmonary resuscitation was performed but ROSC was achieved only after Impella® placement. Discussion In the clinical scenario of Takotsubo cardiomyopathy due to pheochromocytoma, when cardiogenic shock develops treatment is difficult because exogenous catecholamines, required to maintain organ perfusion, could exacerbate hypertension and deteriorate the cardiomyopathy. Moreover, as the coronary perfusion pressure is critically reduced, refractory cardiac arrest could develop. Although veno-arterial extra-corporeal membrane oxygenation (va-ECMO) has been advocated as the treatment of choice for in-hospital refractory cardiac arrest, in the presence of left ventricular overload a device like Impella®, which carries fewer complications as compared to ECMO, could be effective in obtaining the ROSC by unloading the left ventricle.

Coronary Perfusion Pressure During Cardiopulmonary Resuscitation After Spinal Anesthesia in Dogs

1996 ◽  
Vol 82 (1) ◽  
pp. 84-87
Author(s):  
Jack M. Rosenberg ◽  
Joyce A. Wahr ◽  
Ho Choon Sung ◽  
Young Suk Oh ◽  
Lori J. Gilligan
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Spinal Anesthesia ◽  
Perfusion Pressure ◽  
Coronary Perfusion Pressure ◽  
Coronary Perfusion
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