Abstract
ObjectivesResuscitation in the Head Up position improves outcomes in animals treated with active compression decompression cardiopulmonary resuscitation and an impedance threshold device (ACD + ITD CPR).We assessed impact of time to deployment of an automated Head Up position (AHUP) based bundle of care after out-of-hospital cardiac arrest on return of spontaneous circulation (ROSC). MethodsObservational data were analyzed from a patient registry. Patients received treatment with 1) ACD + and/or automated CPR 2) an ITD and 3) an AHUP device. Probability of ROSC (ROSCprob) from the 9-1-1 call to AHUP device placement was assessed with a restricted cubic spline model and linear regression. ResultsOf 11 sites, 6 recorded the interval from 9-1-1 to AHUP device (n = 227). ROSCprobfor all rhythms was 34%(77/227). Median age (range) was 66 years (19-101) and 68% men. TheROSCprobfor shockable rhythms was 47%(18/38). Minutes from 9-1-1 to AHUP device (median, range) varied between sites: 1) 6.4(4,15), 2) 8.0(5,19), 3) 9.9(4, 12), 4) 14.1(6, 36), 5) 15.9(6, 34), 6) 19.0(8, 38),(p = 0.0001).ROSCprobalso varied; 1) 55.1%(16/29), 2) 60%(3/5), 3) 50%(3/6), 4) 22.7%(17/75), 5) 26.4%(9/34), and 6) 37.1%(29/78), (p = 0.019). For all rhythms between 4 and 12 min (n = 85),ROSCprobdeclined 5.6% for every minute elapsed (p = 0.024). For shockable rhythms, between 6 and 15 min (n = 23),ROSCprobdeclined 9.0% for every minute elapsed (p = 0.006). ConclusionsFaster time to deployment of an AHUP based bundle of care is associated with higher incidence of ROSC. This must be considered when evaluating and implementing this bundle.
Highlights
Cardiac arrest remains a leading cause of death in adults in the United States.1 Despite progress with bystander and emergency dispatcher-assisted cardiopulmonary resuscitation (CPR), use of automatic external defibrillators, and therapeutic hypothermia, as well as increased research centered around resuscitation, overall out-of-hospital neurologically-intact survival has remained at or less than 10% for years.1 Recent efforts have focused on a bundle of resuscitation care to increase cardio-cerebral circulation and lower intracranial pressure (ICP) during CPR with the concept of Head Up Position (HUP) CPR
An animal study demonstrated preserved mean arterial pressure (MAP), decreased intracranial pressure (ICP), improved cerebral perfusion pressure (CerPP), and improved cerebral blood flow in swine receiving automated CPR with an impedance threshold device (ITD) when the whole body tilted upwards 30° compared to the supine flat position
Sites were asked for reported intervals from the 9-1-1 call to AHUP device placement and on-scene arrival to AHUP device placement when available, in addition to other data, including age, sex, co-morbidities, medications given, devices used during the resuscitation, and return of spontaneous circulation (ROSC) at any time
Summary
Cardiac arrest remains a leading cause of death in adults in the United States. Despite progress with bystander and emergency dispatcher-assisted cardiopulmonary resuscitation (CPR), use of automatic external defibrillators, and therapeutic hypothermia, as well as increased research centered around resuscitation, overall out-of-hospital neurologically-intact survival has remained at or less than 10% for years. Recent efforts have focused on a bundle of resuscitation care to increase cardio-cerebral circulation and lower intracranial pressure (ICP) during CPR with the concept of Head Up Position (HUP) CPR. Recent efforts have focused on a bundle of resuscitation care to increase cardio-cerebral circulation and lower intracranial pressure (ICP) during CPR with the concept of Head Up Position (HUP) CPR. This novel approach was inspired by a question of whether it was better to transport a patient undergoing CPR with the head up or the feet up when the conventional position was not an option, as seen in high rise apartment buildings with small elevators. An animal study demonstrated preserved mean arterial pressure (MAP), decreased intracranial pressure (ICP), improved cerebral perfusion pressure (CerPP), and improved cerebral blood flow in swine receiving automated CPR with an impedance threshold device (ITD) when the whole body tilted upwards 30° compared to the supine flat position. Whole body head down tilt in that study produced higher ICP and decreased CerPP values.
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