Study: Head-up CPR increases odds of patient surviving neurologically intact

The head and shoulder elevation technique works especially well the if treatment begins less than 18 minutes after the 911 call is received, according to the paper


By Leila Merrill

MINNEAPOLIS, Minn. — Patients suffering a medical cardiac arrest stand a significantly better chance of surviving to discharge neurologically intact from a hospital if they receive a head and shoulder elevation approach to cardiopulmonary resuscitation – especially the if initial treatment using the new approach is started in less than 18 minutes after the 911 call for help is received, according to a new study.

A clinical paper published in the scientific journal Resuscitation states that irrespective of initial cardiac rhythm, even Asystole/Pulseless Electrical Activity, ACE-CPR was associated with higher adjusted odds ratios of survival to hospital discharge relative to conventional supine CPR (C-CPR) when initiated within 18 minutes of the call.

Devices used to provide ACE-CPR: (1) an automated APPD to elevate the head and thorax, (2) a manual active compression-decompression CPR device and/or an automated CPR device attached to the PPD, and (3) an impedance threshold device that attaches to the airway. Abbreviations: CPR = cardiopulmonary resuscitation, APPD = automated patient positioning device, ACE-CPR = automated controlled elevation CPR.
Devices used to provide ACE-CPR: (1) an automated APPD to elevate the head and thorax, (2) a manual active compression-decompression CPR device and/or an automated CPR device attached to the PPD, and (3) an impedance threshold device that attaches to the airway. Abbreviations: CPR = cardiopulmonary resuscitation, APPD = automated patient positioning device, ACE-CPR = automated controlled elevation CPR. (Photo/Take Heart America)

The head-up technique for resuscitation, called ACE-CPR, combines controlled elevation of the head and thorax with active compression-decompression CPR and the use of an impedance threshold device. This technique, the study says, improves neurological survival significantly versus conventional CPR by decreasing intracranial pressure and improving cerebral perfusion pressure and cerebral blood flow.

The ACE-CPR strategy consists of manual ACD-CPR and/or suction cup-based automated CPR; an Impedance Threshold Device (ITDP; and an automated controlled head and thorax patient positioning device (APPD).

The study's 25 authors include: 

  1. Johanna C. Moore, MD, Hennepin Healthcare, Minneapolis, MN; University of Minnesota, Minneapolis, MN; Hennepin Healthcare Research Institute Minneapolis, MN
  2. Paul E Pepe, MD, Dallas County Fire Rescue, University of Texas Health Sciences Center, Houston, TX
  3. Kenneth A. Scheppke, MD, Palm Beach County Fire Rescue, West Palm Beach, FL
  4. Charles Lick, MD, Allina Emergency Medical Services, Minneapolis, MN
  5. Sue Duval, PhD, University of Minnesota, Minneapolis, MN
  6. Joseph Holley, MD, University of Tennessee Health Science Center- Memphis, Memphis, TN
  7. Bayert Salverda, Hennepin Healthcare Research Institute Minneapolis, MN
  8. Michael Jacobs, Alameda County Emergency Medical Services, San Leandro, CA
  9. Paul Nystrom, MD, Hennepin Healthcare, Minneapolis, MN; Hennepin Healthcare, Minneapolis, MN
  10. Ryan Quinn, Hennepin Healthcare, Minneapolis, MN
  11. Paul J. Adams, MD, City of Miami Fire Rescue, Miami, FL
  12. Mack Hutchison, Metropolitan Emergency Medical Services, Little Rock, AR
  13. Mack Hutchison, Metropolitan Emergency Medical Services, Little Rock, AR
  14. Charles Mason, MD, Metropolitan Emergency Medical Services, Little Rock, AR
  15. Eduardo Martinez, Metropolitan Emergency Medical Services, Little Rock, AR
  16. Steven Mason, Metropolitan Emergency Medical Services, Little Rock, AR
  17. Armando Clift, MD, Metropolitan Emergency Medical Services, Little Rock, AR
  18. Peter M. Antevy, MD, Palm Beach County Fire Rescue, West Palm Beach, FL
  19. Charles Coyle, Palm Beach County Fire Rescue, West Palm Beach, FL
  20. Eric Grizzard, Germantown Fire Department, Germantown, TN
  21. Sebastian Garay, Palm Beach County Fire Rescue, West Palm Beach, FL
  22. Remle P. Crowe, Ph.D., ESO Inc, Austin, TX
  23. Keith G Lurie, MD, Hennepin Healthcare, Minneapolis, MN; University of Minnesota, Minneapolis, MN; Hennepin Healthcare Research Institute Minneapolis, MN
  24. Guillaume P. Debaty, MD, Department of Emergency Medicine, University Grenoble Alps/CNRS/TIMC UMR 5525, Grenoble, France
  25. Jose´ Labare`re, MD, Ph.D, University of Grenoble Alpes, Grenoble, France

Podcast

Podcast

Head-up CPR and neuroprotective resuscitation

Wayne Kewitsch and Johanna Moore dig into improving SCA survival and neurological outcomes

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