Norii Tatsuya, Lukas George, Samantaray Aloka, Yabuki Mio, Olasveengen Theresa M, Bray Janet E
Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Resusc Plus. 2025 Jun 16;25:101007. doi: 10.1016/j.resplu.2025.101007. eCollection 2025 Sep.
The impact on survival and neurological outcomes of head-up cardiopulmonary resuscitation (CPR) remains unclear. This systematic review aimed to examine whether head-up CPR or head-up CPR bundle affects survival and neurological outcomes.
In this review registered in PROSPERO (CRD42024541714), we searched Medline, EMBASE, Scopus, Emcare and Cochrane library from inception to February 12, 2025. The inclusion criteria were studies: in adults and children in any setting (in-hospital or out-of-hospital) with cardiac arrest, comparing head-up CPR or head-up CPR bundle with standard or compression-only CPR in supine position, and randomized controlled trials (RCT) and observational studies. We excluded non-human studies and used Cochrane's Risk of Bias-2 and ROBINS-I tools for risk of bias assessment, and GRADE for outcome assessment. We conducted a narrative synthesis of the findings.
We identified four observational studies with 10,099 participants and no RCTs. All outcomes were judged to be very-low certainty of evidence, subject to high-risk of bias. Two pre- and post-intervention studies showed no statistically significant difference in survival with a good neurological outcome. The other two studies, which analyzed overlapping cohorts comparing the head-up CPR bundle with conventional CPR, showed mixed results-one found no statistically significant difference in survival to hospital discharge with favorable neurological status, while the other, focusing on patients with nonshockable rhythms, found that the head-up CPR bundle was associated with increased survival with favorable neurological function.
The available evidence remains limited, highlighted by the absence of RCTs or observational studies with adequate comparisons.
头高位心肺复苏（CPR）对生存及神经功能预后的影响尚不清楚。本系统评价旨在探讨头高位CPR或头高位CPR集束治疗是否会影响生存及神经功能预后。
在本注册于PROSPERO（CRD42024541714）的评价中，我们检索了Medline、EMBASE、Scopus、Emcare和Cochrane图书馆，检索时间从建库至2025年2月12日。纳入标准为：针对任何环境（院内或院外）发生心脏骤停的成人及儿童的研究，比较头高位CPR或头高位CPR集束治疗与仰卧位标准CPR或仅胸外按压CPR，以及随机对照试验（RCT）和观察性研究。我们排除了非人类研究，并使用Cochrane偏倚风险-2和ROBINS-I工具进行偏倚风险评估，使用GRADE进行结局评估。我们对研究结果进行了叙述性综合分析。
我们纳入了4项观察性研究，共10,099名参与者，未纳入RCT。所有结局的证据确定性均被判定为极低，存在高偏倚风险。两项干预前后研究显示，神经功能良好的生存情况无统计学显著差异。另外两项研究分析了重叠队列，比较头高位CPR集束治疗与传统CPR，结果不一——一项研究发现，出院时神经功能良好的生存情况无统计学显著差异；而另一项针对不可电击心律患者的研究发现，头高位CPR集束治疗与神经功能良好的生存率增加相关。
现有证据仍然有限，缺乏充分对照的RCT或观察性研究凸显了这一点。
