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

Authors
  • Park, Yong Joo
  • Hong, Ki Jeong
  • Shin, Sang Do
  • Kim, Tae Yun
  • Ro, Young Sun
  • Song, Kyoung Jun
  • Ryu, Hyun Ho
Type
Published Article
Journal
Clinical and Experimental Emergency Medicine
Publisher
The Korean Society of Emergency Medicine
Publication Date
Sep 30, 2019
Volume
6
Issue
3
Pages
250–256
Identifiers
DOI: 10.15441/ceem.18.060
PMID: 31571441
PMCID: PMC6774013
Source
PubMed Central
Keywords
License
Unknown

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.

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