Does 'heads-up' cardiopulmonary resuscitation improve outcomes for patients in out-of-hospital cardiac arrest? A systematic review.

Andrew Elphinstone,Samantha Laws

doi:10.29045/14784726.2020.12.4.4.16

Abstract

IntroductionSurvival rates for patients in out-of-hospital cardiac arrest have remained around 10% in the United Kingdom for the past seven years. If outcomes are to be improved, research into new methods of advanced life support is required. One such method may be ‘heads-up’ cardiopulmonary resuscitation.Methods:A systematic review of literature exploring heads-up cardiopulmonary resuscitation was conducted in an attempt to identify its effects on survival to discharge and neurological outcome.Results:A comprehensive search of CINAHL, MEDLINE and Google Scholar was undertaken. Six papers were classed as sufficiently relevant for inclusion. Included studies were generally of low quality and none studied the effect of heads-up cardiopulmonary resuscitation on out-of-hospital cardiac arrest patients. Animal studies identified a significant reduction in intracranial pressure and increase in cerebral and coronary perfusion pressure for use of augmented heads-up cardiopulmonary resuscitation in the porcine model of cardiac arrest.Conclusion:Further research is required to analyse the effects and potential benefits of augmented heads-up cardiopulmonary resuscitation in out-of-hospital cardiac arrest.

Highlights

Paramedics in the UK have been trained in the delivery of advanced life support (ALS) since 1979, with techniques being refined and updated over time in an attempt to improve survival to discharge for out of hospital cardiac arrest (OHCA) patients (College of Paramedics, 2015)
Data from National Health Service (NHS) England (2018) show that in August of that year, the survival to discharge of all-cause OHCA patients treated by UK ambulance services was 10.4%, with even fewer than this discharged with favourable neurological outcome
On the basis of these three papers, it is reasonable to conclude that HUPCPR without augmentation of active compressiondecompression (ACD)+impedance threshold device (ITD) would be of unlikely benefit in OHCA patients, further research in human cardiac arrest would be required to form a true conclusion

Summary

Introduction

Paramedics in the UK have been trained in the delivery of advanced life support (ALS) since 1979, with techniques being refined and updated over time in an attempt to improve survival to discharge for out of hospital cardiac arrest (OHCA) patients (College of Paramedics, 2015). Despite these changes, data from National Health Service (NHS) England (2018) show that in August of that year, the survival to discharge of all-cause OHCA patients treated by UK ambulance services was 10.4%, with even fewer than this discharged with favourable neurological outcome (exact percentage unlisted within these statistics). This systematic review sets out to find out if HUPCPR improves patient survival to discharge and neurological outcomes in OHCA by critically analysing the supporting literature of the ‘Heads-Up’ CPR technique

Methods

Findings

Discussion

Conclusion