Consistent head up cardiopulmonary resuscitation haemodynamics are observed across porcine and human cadaver translational models

Johanna C. Moore, Joe Holley, Nicolas Segal, Michael C. Lick, José Labarère, Ralph J. Frascone, Kenneth W. Dodd, Aaron E. Robinson, Charles Lick, Lauren Klein, Andrew Ashton, Angela McArthur, Adamantios Tsangaris, Anna Makaretz, Mike Makaretz, Guillaume Debaty, Paul E. Pepe, Keith G. Lurie

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Aim: The objectives were: 1) replicate key elements of Head Up (HUP) cardiopulmonary resuscitation (CPR) physiology in a traditional swine model of ventricular fibrillation (VF), 2) compare HUP CPR physiology in pig cadavers (PC) to the VF model 3) develop a new human cadaver (HC) CPR model, and 4) assess HUP CPR in HC. Methods: Nine female pigs were intubated, and anesthetized. Venous, arterial, and intracranial access were obtained. After 6 min of VF, CPR was performed for 2 min epochs as follows: Standard (S)-CPR supine (SUP), Active compression decompression (ACD) CPR + impedance threshold device (ITD-16) CPR SUP, then ACD + ITD HUP CPR. The same sequence was performed in PC 3 h later. In 9 HC, similar vascular and intracranial access were obtained and CPR performed for 1 min epochs using the same sequence as above. Results: The mean cerebral perfusion pressure (CerPP, mmHg) was 14.5 ± 6 for ACD + ITD SUP and 28.7 ± 10 for ACD + ITD HUP (p =.007) in VF, −3.6 ± 5 for ACD + ITD SUP and 7.8 ± 9 for ACD + ITD HUP (p =.007) in PC, and 1.3 ± 4 for ACD + ITD SUP and 11.3 ± 5 for ACD + ITD HUP (p =.007) in HC. Mean systolic and diastolic intracranial pressures (ICP) (mmHg) were significantly lower in the ACD + ITD HUP group versus the ACD + ITD SUP group in all three CPR models. Conclusion: HUP CPR decreased ICP while increasing CerPP in pigs in VF as well as in PC and HC CPR models. This first-time demonstration of HUP CPR physiology in humans provides important implications for future resuscitation research and treatment.

Original languageEnglish (US)
Pages (from-to)133-139
Number of pages7
JournalResuscitation
Volume132
DOIs
StatePublished - Nov 2018

Keywords

  • Active compression decompression CPR
  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Cerebral perfusion
  • Head up CPR
  • Human cadaver
  • Impedance threshold device
  • Swine

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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