Aim 

Head and thorax elevation during cardio-pulmonary resuscitation improves cerebral hemodynamics and ultimate neurological outcome after cardiac arrest. Its effect during extracorporeal cardiopulmonary resuscitation (E-CPR) is unknown. We tested whether this procedure could improve hemodynamics in swine treated by E-CPR.

Methods and Results

Pigs were anaesthetized and submitted to 15 min of untreated ventricular fibrillation followed by E-CPR. Animals randomly remained in flat position (flat group) or underwent head and thorax elevation since E-CPR institution (head-up group). Electric shocks were delivered after 30 min until return of spontaneous circulation (ROSC). They were followed during 120-min after ROSC. After 30 min of E-CPR, ROSC was achieved in all animals, with no difference regarding blood pressure, heart rate and extra-corporeal membrane of oxygenation flow among groups. The head-up group had an attenuated increase in ICP as compared to the flat group following cardiac arrest (13 ± 1 vs 26 ± 2 mmHg at the end of the follow-up, respectively). Cerebral perfusion pressure tended to be higher in the head-up vs flat group despite not achieving statistical difference (66 ± 1 vs 46 ± 1 mmHg at the end of the follow-up). Carotid blood flow and cerebral oxygen saturation were not significantly different among groups.

Conclusions 

During E-CPR, head and thorax elevation prevents ICP increase. Whether it could improve the ultimate neurological outcome in this situation deserves further investigation.