Body position during transport in a refractory cardiac arrest porcine model

Abstract

Introduction Cardiac arrest patients are not transported only supine. The effect of body position on resuscitability and cerebral perfusion in a 30degree and 60degree incline is not known. Methods Twenty-five female pigs were subjected to a simulated cardiac arrest (3 minutes no flow, 5 minutes mechanical CPR). Next, animals were randomly assigned to one of the three groups: GROUP 60 (n = 8), 60degree incline for 3 minutes to simulate transport in space restricted elevator; GROUP 30 (n = 8), 30degree incline for 8 minutes to simulate staircase transport; and GROUP 0, with no incline. During subsequent standard CPR including rescue ECMO, resuscitability and cerebral perfusion were assessed. Results Attainment of ROSC (3, 5, 5 in respective groups, P = 0.021), time to ROSC (15:24 (13:26; 16:02) vs. 19:19 (18:28; 19:37) vs. 9:10 minutes (8:28; 9:41), respectively, P = 0.005) significantly differed. Changes in carotid blood flow according to the respective periods of the protocol (baseline, cardiac arrest, initial supine CPR and 30degree vs. 60degree CPR) are depicted in Figure 1. Conclusion Positional changes during simulated refractory cardiac arrest in this experimental model significantly affect resuscitability and brain perfusion. Animals subjected to shorter time in a more inclined (GROUP 60) position were more easily resuscitated; however, cerebral blood flow was better preserved in GROUP 30.