Improving Post-Cardiac Arrest Cerebral Perfusion Pressure by Elevating the Head and Thorax ; L’élévation de la tête et du tronc améliore la pression de perfusion cérébrale en post-arrêt cardiaque

Aim: The optimal head and thorax position after return of spontaneous circulation (ROSC) in cardiac arrest is unknown. The aim of this study was to determine whether head and thorax elevation was beneficial post-ROSC in a porcine model. Methods: We analysed the original data from two randomized controlled studies. In study A, 40kg anesthetized female pigs were positioned supine and flat. After 7.75 minutes of untreated ventricular fibrillation (VF), pigs were elevated to the lowest customized head and thorax elevation device (CED) position. After 8 minutes of untreated VF, automated active compression decompression (ACD) plus impedance threshold device (ITD) CPR was performed for 2 minutes, then pigs were elevated to the highest CED position (HUP) over 2 minutes. After 30 minutes of HUP ACD+ITD CPR pigs were defibrillated, remained elevated for 10 minutes, and then randomized to 5-minutes epochs of Flat, HUP, Flat, HUP or vice versa. Hemodynamics and cerebral oximetry were measured. In study B, after 6 minutes of untreated VF pigs received 6 minutes of conventional (C) CPR flat, and after ROSC were randomized HUP versus Flat as in Study A. The primary endpoint was cerebral perfusion pressure (CerPP). Multivariate analysis-of-variance (MANOVA) for repeated measures was used. Data were reported as mean ± SD and percentage of increase compare to the flat position. Results: Compared with flat position, mean ± SD intracranial pressure (ICP) values for HUP were 9.5±1.8 mmHg (p<0.001) and 8.7±2.3mmHg lower (p<0.001), while CerPP values were 9.3±7.0 mmHg (17%) (p=0.004) and 12.5±5.9 (18%) (p=0.001) higher, in studies A and B, respectively. Conclusion: In a porcine model of cardiac arrest, post-ROSC head and thorax elevation resulted in significantly higher CerPP and lower ICP values, regardless of VF duration or CPR method. ; Objectif : Déterminer si la tête et le tronc doivent rester en position surélevée après le retour d’une activité circulatoire spontanée (RACS) dans un modèle porcin. Méthode : Dans l’étude A, ...