• Johanna C Moore, Nicolas Segal, Michael C Lick, Kenneth W Dodd, Bayert J Salverda, Mason B Hinke, Aaron E Robinson, Guillaume Debaty, and Keith G Lurie.
• Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, United States. Electronic address: Johanna.Moore@hcmed.org.
• Resuscitation. 2017 Dec 1; 121: 195-200.

Aim Of The StudyAs most cardiopulmonary resuscitation (CPR) efforts last longer than 15min, the aim of this study was to compare brain blood flow between the Head Up (HUP) and supine (SUP) body positions during a prolonged CPR effort of 15min, using active compression-decompression (ACD) CPR and impedance threshold device (ITD) in a swine model of cardiac arrest.MethodsVentricular fibrillation (VF) was induced in anesthetized pigs. After 8min of untreated VF followed by 2min of ACD-CPR+ITD in the SUP position, pigs were randomized to 18min of continuous ACD-CPR+ITD in either a 30° HUP or SUP position. Microspheres were injected before VF and then 5 and 15min after start of CPR.ResultsThe mean blood flow (ml/min/g, mean±SD) to the brain after 15min of CPR was 0.42±0.05 in the HUP group (n=8) and 0.21±0.04 SUP (n=10), respectively, (p<0.01). The HUP group also had statistically significantly lower intracranial pressures and higher calculated cerebral perfusion pressures after 5, 15, 19 (before adrenaline) and 20 (after adrenaline) minutes of HUT versus SUP CPR.ConclusionsAfter prolonged ACD-CPR+ITD in the HUP position, brain blood flow was 2-fold higher versus the SUP position. These positive findings provide strong pre-clinical support to proceed with a clinical evaluation of elevation of the head and thorax during ACD-CPR+ITD in humans in cardiac arrest.Copyright © 2017. Published by Elsevier B.V.

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