Not Bad: Passive Leg Raising in Cardiopulmonary Resuscitation-A New Modeling Study.

Yanru Zhang,Yunzhang Cheng,Christer Axelsson,María Jiménez-Herrera

doi:10.3389/fphys.2016.00665

Abstract

Aim: To evaluate, using a simulated haemodynamic circulation model, whether passive leg raising (PLR) is able to improve the effect during cardiopulmonary resuscitation (CPR); to expose the possible reasons why PLR works or not.Materials and Methods: We adapted a circulatory model for CPR with PLR. First we compared cardiac output (CO), coronary perfusion pressure (CPP), blood flow to heart (Qheart), and blood flow to neck and brain (Qhead) of standard chest compression-only CPR with and without PLR; second we simulated the effects of PLR in different situations, by varying the thoracic pump factor (TPF) from 0 to 1; third we simulated the effects when the legs are lifted to the different heights. Finally, we compared our results with those obtained from a published clinical study.Results: According to the simulation model, (1) When TPF is in the interval (0,1), CPP, CO, Qheart, and Qhead are improved with PLR, among them with half-thoracic/half-cardiac pump effect (TPF is 0.5), CPP, CO, Qhead, and Qheart increase the most (by 14, 14, 15, and 17%). (2) When TPF is 1 (pure thoracic pump, with an emphysema or extremely thick thorax), PLR has almost no effect on CPP, CO, and Qheart (−1, 2, and 0%), whereas Qhead is increased by 9%; (3) Regardless of whether there is a cardiac or thoracic pump effect, PLR is able to increase Qhead by 9–15%. (4) When the legs are lifted to 30° to the ground, the volume transferred from legs to upper body is 36% of the initial volume in legs; when the legs are lifted to 45°, the volume transferred is 43%; when the legs are lifted to 60°, the volume transferred is 47%; when the legs are lifted to 90°, the volume transferred is 50%.Conclusion: Generally PLR is able to achieve improved cerebral perfusion and coronary perfusion. In some extreme situations, it has no effect on cardiac output and coronary perfusion, but still improves cerebral perfusion. PLR could be a beneficial supplement to CPR, and it is not necessary to lift the legs too high above the ground.

Highlights

Cardiac arrest (CA) is a sudden stop in effective blood circulation due to the failure of heart contraction (Jameson et al, 2005)
We first referred the value of thoracic pump factor (TPF), for example, to 0.75 [in reference (Babbs, 2005), the blood in adult human can be expelled predominantly by thoracic pump mechanism], to show how Passive leg raising (PLR) works on the circulation
The volume in legs (Vl) is decreased from 415 to 210 ml, 205 ml (49% of the volume) flows to the upper body; the volume in abdomen (Va) is increased from 2102 to 2186 ml, 84 ml stayed in the abdomen; the rest volume flows into the other compartments in the upper body (Figure 3B)

Summary

Introduction

Cardiac arrest (CA) is a sudden stop in effective blood circulation due to the failure of heart contraction (Jameson et al, 2005). It is a major health issue affecting a large population in Europe and the United States (Rea et al, 2004; Atwood et al, 2005). Each year in the United States, 330,000 people suffer a cardiac arrest and only 8% of them survive—leaving 300,000 fatalities Why Learn Cpr and Aed Use? The return to spontaneous circulation (ROSC) rate remains low and more than half of the survivors have different degrees of brain injury (Pusswald et al, 2000; Laver et al, 2004; Nolan et al, 2008; Oddo and Rossetti, 2011)

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