Recent discussions
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Janet Bray
Thank you all for your comments, which will be considered by the BLS Task Force. Janet Bray (BLS Task Force Chair)
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Janet Bray
Thank you all for your comments, which will be considered by the BLS Task Force. Janet Bray (BLS Task Force Chair)
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Janet Bray
Thank you for your comment. Janet Bray (BLS Task Force Chair)
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Ryan Brown
Methodologically sound ScR. Important work with important results. The research backs up my gestalt on access to AEDs.
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Ray saliba
Thanks
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Anwar Adil Mithwani
From : Dr. Anwar Adil Mithwani FRCPCH ( H&SF ID 1732328)
Many thanks to ILCOR for inviting me for the Input on this very crucial topic.
Effects of Head-Up CPR has gained attention in recent years as it shows improving outcomes.
Physiological Basis and Mechanisms of Head-Up CPR
• In the head-up position, gravity assists in draining venous blood from the brain, lowering ICP . This reduction in ICP creates a pressure gradient that favors cerebral perfusion, essential for preserving brain function and improving neurological recovery.
2.Improved Cerebral Perfusion Pressure (CPP):
• Cerebral perfusion pressure, the pressure gradient driving blood flow to the brain, is critical during CPR. Head-Up CPR has been shown in animal studies to enhance CPP
3. Enhanced Coronary Perfusion Pressure:
• The heart’s ability to recover from a cardiac arrest depends heavily on coronary perfusion pressure (CoPP), the difference between the aortic pressure and right atrial pressure during the relaxation phase of CPR. Head-Up CPR may improve CoPP by decreasing venous return and right atrial pressure, making it easier for the heart to receive oxygenated blood, potentially increasing the likelihood of return of spontaneous circulation (ROSC).
4. Optimization of CPR Hemodynamics:
• Head-Up CPR helps distribute blood flow in a more favorable manner. Traditional CPR can cause congestion in the head and thorax,
Challenges and Limitations of Head-Up CPR
1. Logistical Challenges:
• Transitioning patients into a head-up position during cardiac arrest presents logistical challenges. Current CPR protocols focus on minimizing interruption.
2. Lack of Large-Scale Clinical Trials:
• While animal models have shown promising results, large-scale randomized controlled trials (RCTs) in human populations are still lacking. Without robust human data, it remains unclear whether Head-Up CPR will consistently lead to improved survival and neurological outcomes across diverse clinical settings and patient populations.
3. Risk of Suboptimal Chest Compressions:
• Elevating the patient’s head changes the dynamics of chest compressions. There is concern that standard manual chest compressions may be less effective in a head-up position, potentially reducing the effectiveness of CPR if not properly adjusted. Mechanical CPR devices, such as LUCAS or AutoPulse.
4. Timing of Head-Up CPR Implementation:This needs futher studies , large randomized clinical trials as well as multi centre studies to reach to final implementations,,,
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Daniel Cherrier
As per reading this abstract about the head-up CPR, it is obvious to notice by the results of the study, that there are no evidences of more positive outcomes for patients of cardiac arrest by using this performance. I understand that can not be taught in the regular CPR course curriculum. This is an object of study and trial in laboratories only. The regular CPR technique as we know, has made its proofs to increase the chances of survival for cardiac patients after an arrest.. So I thinik that keeping the used way of practice is better for everyone still.
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Brenda Propp
I believe easy access to AED's is critical to the outcome of persons requiring this service however there is a concern of theft or even the pads drying out or being removed, continued research on the best method to make this possible would be my personal recommendation.
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Brenda Propp
I do agree that head up CPR should be used in clinical trial only at this time as the evidence is biased. I also strongly disagree with the use of animal testing as it is cruel and how various animals respond versus humans in not clinically sound. This would be a good case for use of AI.
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Rich Ormonde
Interesting that no RCT have been conducted.
This could be a valuable area to explore.