The Effect of Head Up Cardiopulmonary Resuscitation on Cerebral and Systemic Hemodynamics

Hyun Ho Ryu, Johanna C. Moore, Demetri Yannopoulos, Michael Lick, Scott McKnite, Sang Do Shin, Tae Yun Kim, Anja Metzger, Jennifer Rees, Adamantios Tsangaris, Guillaume Debaty, Keith G Lurie

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Aim: Chest compressions during cardiopulmonary resuscitation (CPR) increase arterial and venous pressures, delivering simultaneous bidirectional high-pressure compression waves to the brain. We hypothesized that this may be detrimental and could be partially overcome by elevation of the head during CPR. Measurements: Female Yorkshire farm pigs (n = 30) were sedated, intubated, anesthetized, and placed on a table able to elevate the head 30° (15 cm) (HUP) and the heart 10° (4 cm) or remain in the supine (SUP) flat position during CPR. After 8 minutes of untreated ventricular fibrillation and 2 minutes of SUP CPR, pigs were randomized to HUP or SUP CPR for 20 more minutes. In Group A, pigs were randomized after 2 minutes of flat automated conventional (C) CPR to HUP (n = 7) or SUP (n = 7) C-CPR. In Group B, pigs were randomized after 2 minutes of automated active compression decompression (ACD) CPR plus an impedance threshold device (ITD) SUP CPR to either HUP (n = 8) or SUP (n = 8). Results: The primary outcome of the study was difference in CerPP (mmHg) between the HUP and SUP positions within groups. After 22 minutes of CPR, CerPP was 6 ± 3 mmHg in the HUP versus -5 ± 3 in the SUP (p = 0.016) in Group A, and 51 ± 8 versus 20 ± 5 (p = 0.006) in Group B. Coronary perfusion pressures after 22 minutes were HUP 6 ± 2 vs SUP 3 ± 2 (p = 0.283) in Group A and HUP 32 ± 5 vs SUP 19 ± 5, (p = 0.074) in Group B. In Group B, 6/8 pigs were resuscitated in both positions. No pigs were resuscitated in Group A. Conclusions: The HUP position in both C-CPR and ACD + ITD CPR significantly improved CerPP. This simple maneuver has the potential to improve neurological outcomes after cardiac arrest.

Original languageEnglish (US)
Pages (from-to)29-34
Number of pages6
StatePublished - May 1 2016


  • Active compression decompression CPR
  • Cardiac Arrest
  • Cardiopulmonary resuscitation
  • Cerebral perfusion
  • Impedance threshold device
  • Mechanical CPR

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