Heads up CPR

[Groove]

Anybody else have any EMS agencies implementing this? We reportedly have a pilot program in place and I can't even seem to find any human data supporting this yet. It's all derived from pig studies. Color me extremely skeptical that this will end up making any difference whatsoever. EMS here seems to continually jump onboard with novel ideas propped up on shaky data before there's any real proven benefit. Here's a link supporting heads up CPR and a contradicting perspective. I really haven't researched this enough yet to formulate an opinion but my limited lit search this morning hasn't improved my confidence. Am I missing something?

Head-Up CPR May Improve Neurologically Intact Survival Rates - JEMS: EMS, Emergency Medical Services - Training, Paramedic, EMT News

Head-up CPR, when applied correctly and as part of a OHCA bundle of care, has the potential to improve neurologically intact survival rates after cardiac arrest.

www.jems.com

Why heads-up CPR is NOT ready for out-of-hospital cardiac arrest care

EMS clinical leaders need to review and consider the research before implementing a new CPR technique

www.ems1.com

I think if I had one of these come in I'd arch an eyebrow, let out a small sigh, lay them flat again and continue the resus.

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[Siggy]

The very first reference is the study they did in humans in Palm Beach County, Florida. Dr. Pepe talked a bit about this study at the Society for Critical Care Medicine National Congress this year. Granted, there's simple things like adding a metronome because people love giving compressions at 200/minute that I would add before doing this (unless you're already using mechanical compression devices), but I wouldn't lay someone flat who was already heads up unless I have a reason to do so. On an actedotal note, I've seen a lot more ROSC on floor/unit codes once I slow down the nurse/tech/student doing compressions using a $10 metronome I bought online.

Confirming the Clinical Safety and Feasibility of a Bundled Methodology to Improve Cardiopulmonary Resuscitation Involving a Head-Up/Torso-Up Chest Compression Technique - PMC

Combined with devices that enhance venous return out of the brain and into the thorax, preclinical outcomes are improved significantly using a synergistic bundled approach involving mild elevation of the head and chest during cardiopulmonary ...

www.ncbi.nlm.nih.gov

I mean, we're only talking about a study of over 2,000 people which resulted in a doubling of neurologically intact discharge. That's more patients with a bigger outcome difference than other "standards of care" (I'm looking at you, albumin in SBP) that you're scoffing at. Also, the paramedic who wrote the article obviously didn't read his references, considering he's citing the human study to say, "There's no human studies."

 

[Groove]

Thanks, interesting... So what are they recommending for the pts arriving with ongoing ACLS to the ED? Keep them 20-30 degrees for the remainder of the code?

Is anyone’s hospital utilizing heads up CPR for floor codes?

The very first reference is the study they did in humans in Palm Beach County, Florida. Dr. Pepe talked a bit about this study at the Society for Critical Care Medicine National Congress this year. Granted, there's simple things like adding a metronome because people love giving compressions at 200/minute that I would add before doing this (unless you're already using mechanical compression devices), but I wouldn't lay someone flat who was already heads up unless I have a reason to do so. On an actedotal note, I've seen a lot more ROSC on floor/unit codes once I slow down the nurse/tech/student doing compressions using a $10 metronome I bought online.

Confirming the Clinical Safety and Feasibility of a Bundled Methodology to Improve Cardiopulmonary Resuscitation Involving a Head-Up/Torso-Up Chest Compression Technique - PMC

Combined with devices that enhance venous return out of the brain and into the thorax, preclinical outcomes are improved significantly using a synergistic bundled approach involving mild elevation of the head and chest during cardiopulmonary ...

www.ncbi.nlm.nih.gov

I mean, we're only talking about a study of over 2,000 people which resulted in a doubling of neurologically intact discharge. That's more patients with a bigger outcome difference than other "standards of care" (I'm looking at you, albumin in SBP) that you're scoffing at. Also, the paramedic who wrote the article obviously didn't read his references, considering he's citing the human study to say, "There's no human studies."

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[thegenius]

No.

 

[Siggy]

Is anyone’s hospital utilizing heads up CPR for floor codes?

The actual protocol requires both an impedance threshold device (ITD) and mechanical CPR with active compression/decompression (Lucas device) with the tilt being added over several minutes. I've yet to see a hospital with an ITD or a mechanical CPR device.

 

[TooMuchResearch]

I don't think LUCAS has active decompression.

The actual protocol requires both an impedance threshold device (ITD) and mechanical CPR with active compression/decompression (Lucas device) with the tilt being added over several minutes. I've yet to see a hospital with an ITD or a mechanical CPR device.

 

[Siggy]

The LUCAS-2 and 3 has a suction cup accessory for active decompression.

Emergency Care

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www.physio-control.com

 

[southerndoc]

The suction cup on the LUCAS device is to help maintain the compression site and also to spread the compression area to help prevent sternal fractures. The LUCAS-3 is designed to do ACD CPR (doesn't do a great job in my opinion), but it is not FDA approved and therefore not activated yet.

We (Cobb County Fire & Emergency Services) started utilizing active compression-decompression CPR with a ResQPump (ResQCPR) and an impendence threshold device (ResQPod) 2 years ago. Our out-of-hospital cardiac arrest survival-to-discharge rates went from 3.8% to 12.5%. We consider CPC1 and CPC2 as survivors. CPC3 and 4 are considered non-survivors for our data. We are working on publishing it.

We are in the process of planning to implement HeadsUp CPR. Our goal is to get to 40% OHCA survival rate with CPR being required for graduation from high school, AED's required for business licenses with more than $500,000 in revenue, and hopefully eventually AED's on police cars.

It's a long process, but I'm hoping we can get there. Kevin Lurie (the cardiologist who oversees Zoll's ResQPump, ResQPod, and HeadsUp CPR) is a great resource for information on it.

 

[deleted109597]

We started using the ResQPod in 2009 or 2010 at ECU. I'm sure other hospitals use it now. Not all of them, for sure, but plenty. And if they aren't, we should be questioning why not.

 

[RustedFox]

It seems like my local EMS crews have abandoned these auto-CPR devices. I haven't seen one in action in awhile now.

 

[Siggy]

We started using the ResQPod in 2009 or 2010 at ECU. I'm sure other hospitals use it now. Not all of them, for sure, but plenty. And if they aren't, we should be questioning why not.

My understanding was that the initial evidence for ITDs was promising, but followup studies weren't as promising (the same for ACD alone). The combination of ACD AND ICDs, on the other hand, did show promise.


Also, the Dr. Pepe SCCM lecture is available online.

 

[FiremedicMike]

It seems like my local EMS crews have abandoned these auto-CPR devices. I haven't seen one in action in awhile now.

really? Wow that surprises me, I don’t think there’s a single department around me that doesn’t use mechanical CPR..

 

[BoardingDoc]

really? Wow that surprises me, I don’t think there’s a single department around me that doesn’t use mechanical CPR..

Same. Live in a major metro area. I'll get at most 1 arrest in 20 which comes in on with mechanical CPR ongoing. Everyone else is by hand.

 

[Groove]

9 times out of 10 our arrests come in on a LUCAS device.

 

[FiremedicMike]

So being heavily involved in EMS education and QI, I'm very interested in heads-up CPR.. Unfortunately I think the current studies are lacking, specifically as it relates to the technique. From Eagles this past year where Dr. Pepe and several others discussed their study, there was a variety of different means for elevating the head, including such ideas as several minutes of CPR before raising the head and my personal "favorite" which was raising the head slowly over the course of 2 minutes, which I find to be unrealistic in the real world..

Heads up CPR makes sense to me, given everything we discussed when we got rid of backboards regarding physiologic issues with laying flat, and I'm honestly surprised heads up CPR isn't already more common.. I'm on the fence on the ITD.. Again the physics and theory of it make sense, but we've not noticed much of a change since implementing it (in fairness, compliance with application isn't that high...)

I'm going to have to seriously consider the lucas-2 if it's really ACD.. We've been using the autopulse almost since it's release, but ACD also makes sense to me and a device that does that has the potential to be a game-changer..

 

[FiremedicMike]

If anyone is interested, I finally got an answer from my physio sales rep - the lucas is not officially considered or allowed to be marketed as an active decompression device..