Improving post-cardiac arrest cerebral perfusion pressure by elevating the head and thorax.
Resuscitation
; 159: 45-53, 2021 02.
Article
em En
| MEDLINE
| ID: mdl-33385469
ABSTRACT
AIM:
The optimal head and thorax position after return of spontaneous circulation (ROSC) following cardiac arrest (CA) is unknown. This study examined whether head and thorax elevation post-ROSC is beneficial, in a porcine model.METHODS:
Protocol A 40â¯kg anesthetized pigs were positioned flat, after 7.75â¯min of untreated CA the heart and head were elevated 8 and 12â¯cm, respectively, above the horizontal plane, automated active compression decompression (ACD) plus impedance threshold device (ITD) CPR was started, and 2â¯min later the heart and head were elevated 10 and 22â¯cm, respectively, over 2â¯min to the highest head up position (HUP). After 30â¯min of CPR pigs were defibrillated and randomized 10â¯min later to four 5-min epochs of HUP or flat position. Multiple physiological parameters were measured. In Protocol B, after 6â¯min of untreated VF, pigs received 6â¯min of conventional CPR flat, and after ROSC were randomized HUP versus Flat as in Protocol A. The primary endpoint was cerebral perfusion pressure (CerPP). Multivariate analysis-of-variance (MANOVA) for repeated measures was used. Data were reported as mean⯱â¯SD.RESULTS:
In Protocol A, intracranial pressure (ICP) (mmHg) was significantly lower post-ROSC with HUP (9.1⯱â¯5.5) versus Flat (18.5⯱â¯5.1) (pâ¯<â¯0.001). Conversely, CerPP was higher with HUP (62.5⯱â¯19.9) versus Flat (53.2⯱â¯19.1) (pâ¯=â¯0.004), respectively. Protocol A and B results comparing HUP versus Flat were similar.CONCLUSION:
Post-ROSC head and thorax elevation in a porcine model of cardiac arrest resulted in higher CerPP and lower ICP values, regardless of VF duration or CPR method. IACUC PROTOCOL NUMBER 19-09.Palavras-chave
Active compression-decompression CPR; Advanced cardiac life support; Cardiac arrest; Cardiopulmonary resuscitation; Cerebral perfusion pressure; Head Up CPR; Head and thorax elevation; Heart arrest; Impedance threshold device; Intracranial pressure; Medical device; Patient positioning; Posture; Return of spontaneous circulation
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Reanimação Cardiopulmonar
/
Parada Cardíaca
Limite:
Animals
Idioma:
En
Revista:
Resuscitation
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
França