Passive leg raising during cardiopulmonary resuscitation results in improved neurological outcome in a swine model of prolonged ventricular fibrillation

• Published in: The American journal of emergency medicine 2012-11, Vol.30 (9), p.1935-1942
• Main Authors: Dragoumanos, Vasileios, MSc, Iacovidou, Nicoletta, PhD, Chalkias, Athanasios, PhD, Lelovas, Pavlos, MSc, Koutsovasilis, Anastasios, MSc, Papalois, Apostolos, PhD, Xanthos, Theodoros, PhD
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Biological and medical sciences; Blood Pressure; Brain damage; Cardiac arrhythmia; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; CPR; Disease Models, Animal; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency medical care; Extremities; Heart attacks; Heart Rate; Hogs; Hypoxia, Brain - etiology; Hypoxia, Brain - prevention & control; Intensive care medicine; Male; Medical research; Medical sciences; Patient Positioning; Studies; Survival; Swine; Treatment Outcome; Veins & arteries; Ventricular Fibrillation - complications; Ventricular Fibrillation - therapy
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2012.04.014

Abstract Objective The objective was to evaluate whether passive leg raising during cardiopulmonary resuscitation in a porcine model of prolonged ventricular fibrillation improves hemodynamics, return of spontaneous circulation, 24-hour survival, and neurological outcome. Methods Ventricular fibrillation was induced in 20 healthy Landrace/Large White piglets, which were subsequently left untreated for 8 minutes. Ten animals were randomly assigned into the control group and were resuscitated according to the 2005 European Resuscitation Council guidelines, and 10 piglets were assigned into the passive leg raising group and were resuscitated with the legs passively raised at 45° with the aid of a special purpose-made metallic device. End points were either return of spontaneous circulation or asystole. Results Return of spontaneous circulation was observed in 6 and 9 animals from the control and the passive leg raising group, respectively ( P = .121; odds ratio = 0.16; 95% confidence interval, 0.01-1.87). Just prior to the first defibrillation attempt, coronary perfusion pressure was significantly higher in the passive leg raising group (22.8 ± 9.5 vs 10.6 ± 6.5 mm Hg, P < .004); but no subsequent significant differences were observed. Although all animals that restored spontaneous circulation survived for 24 hours, neurologic alertness score was significantly better in the animals treated with passive leg raising (90 ± 10 vs 76.6 ± 12.1, P = .037). Conclusions Passive leg raising during cardiopulmonary resuscitation significantly increased coronary perfusion pressure in the minute prior to the first shock. Return of spontaneous circulation and 24-hour survival rate were comparable between groups. However, the animals in the passive leg raising group exhibited significantly higher neurological scores.