• Guillaume Debaty, Nicolas Segond, Helene Duhem, Christophe Crespi, Alexandre Behouche, Johanna Boeuf, Caroline Sanchez, Tahar Chouihed, Johanna Moore, Keith Lurie, and José Labarere.
• Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France; Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France. Electronic address: gdebaty@gmail.com.
• Resuscitation. 2024 Nov 1; 204: 110406110406.

BackgroundThe combination of controlled automated head/thorax elevation, active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), and an impedance threshold device (ITD-16), termed AHUP-CPR, lowers intracranial pressure and increases circulation and neurologically-sound survival in pigs versus conventional (C) CPR. This study examined whether AHUP-CPR increased end tidal (ET) CO2, a non-invasive marker of cardiac output and organ perfusion, compared with C-CPR in witnessed out-of-hospital cardiac arrest patients.MethodWe conducted a prospective, single-arm, pre-post intervention trial in France between October 2019 and October 2022.Firefighters treated patients enrolled during the pre-intervention period with manual C-CPR and with AHUP-CPR during the post-intervention period. Advanced life support was provided by a physician-staffed 2nd-tier response vehicle for the two study periods. The primary outcome was the peak ETCO2 value measured during CPR.Results122 patients with a mean age of 67 years (standard deviation [SD], 17) were enrolled (59 in the pre-intervention period and 63 in the post-intervention period). Based on an intention-to-treat analysis, mean baseline ETCO2 values were comparable between pre- (20.1 mmHg, SD,16.3) and post-(19.2 mmHg, SD, 16.3) intervention periods. Mean peak ETCO2 values during CPR were 30.3 mmHg (SD, 13.1) versus 40.7 mmHg (SD, 17.8) for the pre- and post-intervention study periods (mean difference, 10.6, 95% confidence interval, 4.6 to 16.1, P < 0.001). Mean differences in peak ETCO2 between study periods did not vary according to the first recorded cardiac rhythm (P for interaction = 0.99). The proportion of return of spontaneous circulation [19 (32.2%) vs. 21 (33.3%)], survival on hospital admission [17 (28.8%) vs. 19 (30.2%)], and 30-day survival with favorable neurological outcome [8 (13.6%) vs. 7 (11.1%)] did not differ between study periods.ConclusionETCO2 values during AHUP-CPR reached the range of non-arrest normal physiological levels and were significantly higher than with C-CPR, regardless of the presenting cardiac rhythm.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

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