Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Hennepin Healthcare Research Institute, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
Resuscitation. 2020 May;150:23-28. doi: 10.1016/j.resuscitation.2020.02.023. Epub 2020 Feb 27.
Elevation of the head and thorax (HUP) during cardiopulmonary resuscitation (CPR) has been shown to double brain blood flow with increased cerebral perfusion pressures (CerPP) after active compression-decompression (ACD) CPR with an impedance threshold device (ITD). However, the optimal angle for HUP CPR is unknown.
In Study A, different angles were assessed (20°, 30°, 40°), each randomized over 5-min periods of ACD + ITD CPR, after 8 min of untreated ventricular fibrillation in an anesthetized swine model. Based upon Study A, Study B was performed, where animals were randomized to 1 of 2 sequences: 20°, 30°, 40° or 40°, 30°, 20° with a similar protocol. The primary endpoint was CerPP for both studies.
In Study A, no optimal HUP angle was observed in 18 pigs. CerPPs for 30° and 40° (mmHg, mean ± SD) were equivalent (44 ± 22 and 47 ± 26, p = 0.18). However, CerPP appeared higher when 40° HUP was performed during the last 5-min of CPR, suggestive of a sequence effect. For Study B, after 17 min of CPR, CerPP (mmHg) were higher with the 20°, 30°, 40° sequence: 60 ± 17 versus 33 ± 18 (p = 0.035).
No optimal HUP CPR angle was observed. However, controlled progressive elevation of the head and thorax during CPR is more beneficial than an absolute angle or height to maximize CerPP. Further studies are needed to determine the optimal rate of rise during HUP ACD + ITD CPR.
17-06.
在使用阻抗阈值设备（ITD）进行主动按压-释放（ACD）心肺复苏（CPR）期间，抬高头部和胸部（HUP）已被证明可使脑血流增加一倍，并使脑灌注压（CerPP）升高。然而，HUP CPR 的最佳角度尚不清楚。
在研究 A 中，评估了不同的角度（20°、30°、40°），在麻醉猪模型室颤 8 分钟后，每个角度随机进行 5 分钟的 ACD+ITD CPR。基于研究 A，进行了研究 B，其中动物随机分为 2 个序列之一：20°、30°、40°或 40°、30°、20°，使用相似的方案。主要终点是两项研究的 CerPP。
在研究 A 中，在 18 头猪中未观察到最佳 HUP 角度。30°和 40°的 CerPP（mmHg，平均值±标准差）相等（44±22 和 47±26，p=0.18）。然而，当在 CPR 的最后 5 分钟进行 40° HUP 时，CerPP 似乎更高，提示存在序列效应。对于研究 B，在 CPR 17 分钟后，20°、30°、40°序列的 CerPP（mmHg）更高：60±17 与 33±18（p=0.035）。
未观察到最佳 HUP CPR 角度。然而，在 CPR 期间控制头部和胸部逐渐升高比绝对角度或高度更有利于最大限度地提高 CerPP。需要进一步研究以确定 HUP ACD+ITD CPR 期间上升的最佳速度。
17-06。
