Body position during transport in a refractory cardiac arrest porcine model

Introduction

Cardiac arrest patients are not transported only supine. The effect of body position on resuscitability and cerebral perfusion in a 30° and 60° 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), 60° incline for 3 minutes to simulate transport in space restricted elevator; GROUP 30 (n = 8), 30° 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 30° vs. 60° CPR) are depicted in Figure 1.

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.