101. Tilting for perfusion: head-up position during cardiopulmonary resuscitation improves brain flow in a porcine model of cardiac arrest
- Author
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Anja Metzger, Timothy Matsuura, Tae Yun Kim, Michael Lick, Sang Do Shin, Scott McKnite, Keith G. Lurie, Demetris Yannopoulos, Jennifer Rees, Guillaume Debaty, Hyun Ho Ryu, Physiologie cardio-Respiratoire Expérimentale Théorique et Appliquée (TIMC-IMAG-PRETA), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), and Centre Hospitalier Universitaire [Grenoble] (CHU)
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Resuscitation ,Supine position ,Head-up position ,Swine ,medicine.medical_treatment ,Venous circulation ,Emergency Nursing ,Patient Positioning ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Medicine ,Animals ,Humans ,Cardiopulmonary resuscitation ,Cerebral perfusion pressure ,ComputingMilieux_MISCELLANEOUS ,business.industry ,Brain ,Impedance threshold device ,Heart Arrest ,Regional Blood Flow ,Anesthesia ,Cerebrovascular Circulation ,Ventricular Fibrillation ,Emergency Medicine ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Gravitation - Abstract
Cerebral perfusion is compromised during cardiopulmonary resuscitation (CPR). We hypothesized that beneficial effects of gravity on the venous circulation during CPR performed in the head-up tilt (HUT) position would improve cerebral perfusion compared with supine or head-down tilt (HDT).Twenty-two pigs were sedated, intubated, anesthetized, paralyzed and placed on a tilt table. After 6min of untreated ventricular fibrillation (VF) CPR was performed on 14 pigs for 3min with an automated CPR device called LUCAS (L) plus an impedance threshold device (ITD), followed by 5min of L-CPR+ITD at 0° supine, 5min at 30° HUT, and then 5min at 30° HDT. Microspheres were used to measure organ blood flow in 8 pigs. L-CPR+ITD was performed on 8 additional pigs at 0°, 20°, 30°, 40°, and 50° HUT.Coronary perfusion pressure was 19±2mmHg at 0° vs. 30±3 at 30° HUT (p0.001) and 10±3 at 30° HDT (p0.001). Cerebral perfusion pressure was 19±3 at 0° vs. 35±3 at 30° HUT (p0.001) and 4±4 at 30° HDT (p0.001). Brain-blood flow was 0.19±0.04mlmin(-1)g(-1) at 0° vs. 0.27±0.04 at 30° HUT (p=0.01) and 0.14±0.06 at 30° HDT (p=0.16). Heart blood flow was not significantly different between interventions. With 0, 10, 20, 30, 40 and 50° HUT, ICP values were 21±2, 16±2, 10±2, 5±2, 0±2, -5±2 respectively, (p0.001), CerPP increased linearly (p=0.001), and CPP remained constant.During CPR, HDT decreased brain flow whereas HUT significantly lowered ICP and improved cerebral perfusion. Further studies are warranted to explore this new resuscitation concept.
- Published
- 2014
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