Worsened survival in the head-up tilt position cardiopulmonary resuscitation in a porcine cardiac arrest model
- Author:
Yong Joo PARK
1
;
Ki Jeong HONG
;
Sang Do SHIN
;
Tae Yun KIM
;
Young Sun RO
;
Kyoung Jun SONG
;
Hyun Ho RYU
Author Information
- Publication Type:Original Article
- Keywords: Heart arrest; Cardiopulmonary resuscitation; Animal experimentation
- MeSH: Advanced Cardiac Life Support; Agriculture; Animal Experimentation; Cardiopulmonary Resuscitation; Electric Impedance; Female; Head; Heart Arrest; Humans; Models, Theoretical; Supine Position; Survival Rate; Swine; Ventricular Fibrillation
- From: Clinical and Experimental Emergency Medicine 2019;6(3):250-256
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVE: Head elevation at an angle of 30° 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° 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.
