Clinical Confirmation of Profound Improvements in Neuro-Intact Survival Using the Head-Up CPR Bundle
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Resuscitation, Neuroscience, 2022
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INTRODUCTION: The modified physiological approach to CPR using head-up/torso-up (HTup) positions and adjuncts to lower ICP (and enhance venous return) clearly facilitates neuro-intact survival pre-clinically and markedly improves resuscitation rates in pilot clinical studies of out-of-hospital cardiac arrest (OHCA). The purpose here was to confirm improved neuro-intact patient survival (SNI) using this method. METHODS: Prospectively-collected data were obtained from a national AHUP registry in which 6 participating EMS agencies routinely tracked SNI for OHCA as well as T911-CPR, the elapsed time from 9-1-1 call to initiation of an automated HTup CPR device (AHUP) combined with manual (or automated) active compression-decompression and impedance threshold devices (all FDA-cleared). AHUP steadily elevates the head/torso over several minutes (occiput reaching 22 cm). For rigorous comparisons, conventional CPR (C-CPR) controls were derived from 3 large-scale published OHCA trials involving 5,330 patients from high-performance EMS systems including those that closely monitored, recorded and reported quality of CPR. Multivariate and propensity score analyses accounted for imbalances in characteristics (age; sex; bystander-witnessed; bystander CPR; shockable rhythm; T911-CPR (C-CPR or AHUP initiation). Each AHUP patient (n=227) was matched with up to 4 C-CPR patients (n=930) in propensity analysis. SNI was defined as achieving mRS3 (or CPC 1 or 2 in one study). RESULTS: Regardless of presenting cardiac rhythm, early initiation (T911-CPR < 20min) of the AHUP bundle was associated with profoundly higher rates of SNI vs. current published findings. Even compared to high-performance/highly-monitored EMS systems and stratified by T911-CPR, SNI differences with the AHUP resuscitation bundle became increasingly more significant than C-CPR with shorter T911-CPR (eg, SNI was nearly 3-fold higher with T911-CPR < 13 mins [OR 2.68; 95%CI=1.17-6.13] and nearly 5-fold higher [OR 4.74; 95%CI=1.40-16.01] if < 8 mins). CONCLUSIONS: The HTup CPR resuscitation bundle was associated with markedly improved odds of neurologically-favorable OHCA survival versus C-CPR even when comparing well-matched controls with closely-monitored CPR performance. Moreover, shorter times to bundle initiation further augment the odds of neuro-intact survival.
Meta Tag
Content Type Presentation
Knowledge Area Resuscitation
Knowledge Area Neuroscience
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Cardiopulmonary Resuscitation CPR
Tag Cerebral Blood Flow
Year 2022
Head Up CPR bundle
cardiac arrest patients
impedance threshold device
active compression decompression device
neurologically intact survival rates


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