Abstract 87: Head-up Cardiopulmonary Resuscitation Increases Cerebral Perfusion Pressure in a Porcine Model of Cardiac Arrest
Introduction: The optimal head position during cardiopulmonary resuscitation (CPR) with enhanced perfusion delivered with the combination of LUCAS-2, an automated active compression decompression device (L-CPR), and an inspiratory impedance threshold device (ITD) to increase circulation, is unknown. The aim of this study was to determine the relationship between head-up angle relative to the horizontal plane that minimizes intracranial pressure (ICP) and optimizes cerebral perfusion pressure (CerPP) during L-CPR-ITD.
Method: Six female pigs (38±0.3 kg) were sedated, intubated, anesthetized with isofluorane, paralyzed with succinylcholine (93.3 μg/kg/min) and placed on a tilt table. After 6 minutes of untreated ventricular fibrillation and 4 minutes of baseline CPR at 0°, L-CPR (Lucas-2, Physio-Control, Redmond, WA) +ITD (ResQPOD 16, Advanced Circulatory Systems, Roseville, MN) was performed at 0, 10, 20, 30, 40 and 50° head up position for 1 minute intervals. Hemodynamics and ICP were recorded continuously. Calculated coronary perfusion pressure (CPP) (diastolic aortic - right atrial pressure) and cerebral perfusion pressure (CePP) (aortic - ICP) were measured continuously. Repeated measures ANOVA with linear trend was used for statistical analysis. Data are expressed as mean ± SEM with pressures in mmHg.
Results: With 0, 10, 20, 30, 40 and 50° head up positioning, mean icp decreased linearly as follows: 21±3, 16±2, 11±3, 6±2, 1±3, -3±2 respectively, (p<0.001) As shown in the figure, CPP remained stable but CePP increased linearly (p=0.004) with head elevation.
Conclusion: During L-CPR- ITD in pigs, mean ICP decreased and CerPP increased linearly until 50° head-up positioning. The discovery that head-up angle improves brain perfusion pressures during L-CPR+ITD has the potential to improve neurological outcomes after cardiac arrest.
Author Disclosures: G. Debaty: None. S. Shin: None. A. Metzger: Employment; Significant; Advanced Circulatory Systems, Inc.. H. Ryu: None. T. Kim: None. J. Rees: Employment; Significant; Advanced Circulatory Systems, Inc.. S. McKnite: None. T. Matsuura: None. M. Lick: Employment; Significant; Advanced Circulatory Systems, Inc. D. Yannopoulos: Research Grant; Significant; NIH 1R01HL123227-02; R01HL108926-04. K. Lurie: Employment; Significant; Advanced Circulatory Systems, Inc.. Ownership Interest; Significant; Advanced Circulatory Systems, Inc..
- © 2014 by American Heart Association, Inc.