Clin Exp Emerg Med.  2019 Sep;6(3):250-256. 10.15441/ceem.18.060.

Worsened survival in the head-up tilt position cardiopulmonary resuscitation in a porcine cardiac arrest model

Affiliations
  • 1Department of Emergency Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea.
  • 2Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea. ssberg@snu.ac.kr
  • 3Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
  • 4Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
  • 5Department of Emergency Medicine, Chonnam National University School of Medicine, Gwangju, Korea.

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.

Keyword

Heart arrest; Cardiopulmonary resuscitation; Animal experimentation
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