Worsened Survival In The Head-Up Tilt Position Cardiopulmonary Resuscitation In A Porcine Cardiac Arrest Model
CLINICAL AND EXPERIMENTAL EMERGENCY MEDICINE(2019)
Abstract
Objective Head elevation at an angle of 30 degrees during cardiopulmonary resuscitation (CPR) was hemodynamically beneficial compared to supine position in a previous porcine cardiac arrest experimental study. However, survival benefit of head-up elevation during CPR has not been clarified. This study aimed to assess the effect of head-up tilt position during CPR on 24-hour survival in a porcine cardiac arrest experimental model.Methods This was a randomized experimental trial using female farm pigs (n=18, 42 +/- 3 kg) sedated, intubated, and paralyzed on a tilting surgical table. After surgical preparation, 15 minutes of untreated ventricular fibrillation was induced. Then, 6 minutes of basic life support was performed in a position randomly assigned to either head-up tilt at 30 degrees or supine with a mechanical CPR device, LUCAS-2, and an impedance threshold device, followed by 20 minutes of advanced cardiac life support in the same position. Primary outcome was 24-hour survival, analyzed by Fisher exact test.Results In the 8 pigs from the head-up tilt position group, one showed return of spontaneous circulation (ROSC); all eight pigs expired within 24 hours. In the eight pigs from the supine position group, six had the ROSC; six pigs survived for 24 hours and two expired. The head-up position group showed lower 24-hour survival rate and lower ROSC rate than supine position group (P<0.01).Conclusion The use of head-up tilt position with 30 degrees during CPR showed lower 24-hour survival than the supine position.
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Key words
Heart arrest, Cardiopulmonary resuscitation, Animal experimentation
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