Heads-Up CPR: A Lifesaving Innovation in High-Rise Apartments - Essay Sample

Introduction

The concept of heads-up CPR began through a conversation underpinning elevators. Understandably, several people lived in the high-rise apartments in Southern Korea; hence, it was very difficult for the emergency crews to perform CPR as they bring patients with cardiac arrest down from the apartments. In light of this, many people promoted the designing of a wheeled foldable stretcher-cart, in which a cardiologist Keith Lure from the University of Minnesota, identified a prototype. According to Lurie, people had a manikin on the stretcher, and when they reached the elevator, they had to conduct a CPR as they placed manikins up (Lurie et al., 2019). Their inquisitiveness increased, and a group of people including Sand Do Shin, Guillaume Debaty who was a French emergency physician and Lurie, all immediately gathered at the University laboratory for further studies of the idea through a pig model (Putzer et al., 2018). The result revealed that using head-down or feet-up position when performing resuscitation leads to increased intracranial pressure and reduces the cerebral perfusion pressure. Still, head-up position causes an increase of the CPP and ICP fall.

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Previous research has also found that during the CPR performance, the head-up position at an angle of approximately 30 degrees had hemodynamic benefits based on cerebral perfusion pressure and coronary perfusion pressure, compared to the head-down (Putzer et al., 2018). Notably, higher cerebral perfusion pressure has demonstrated an increase in the rate of survival. Unfortunately, the study failed to show the relationship between the head-up position and the 24 hours of survival during CPR performance (Lurie et al., 2019). The paper seeks to critically analyze the concept of head-up CPR through exploring different aspects, including its anatomy, physiology, methods and materials utilized in administering and providing successful examples as well as exploring the scope of its practice and the costs of the required products.

Anatomy

Due to the clinical question of whether to transport a patient in cardiac arrest either feet-up or head-up in a small elevator, some studies have been conducted since 2014, with the main focus on the animal’s anatomy (Illindala, 2016). The study used a swine model of cardiac arrest, in which a pig was utilized in more than four minutes through automated CPR process using an impedance threshold device (ITD-16), the animal was placed 30-degree head-up and then the same degree head-down. The result indicated that the cerebral perfusion pressure and the cerebral blood flow were recorded higher when the body tilted up and lower when the body was flat (Lurie et al., 2019). Again, the intracranial pressure was recorded lower with the head-up. More precisely, the ICP and the CerPP were reported higher and lower respectively with the whole-body head-down.

In other studies where the body of the animal took more time of the CPR, in which thorax and the head of the pig were elevated for more than twenty minutes of active compression decomposition plus the application of ITD-16, to lower the venous pooling in the lower extremes at the resuscitation. It was found that the CPP increased and could sustain the process for the entire period when the head was up and when the body was flat (Putzer et al., 2018). On another experiment that applied a similar protocol of a prolonged period with the head-up and ACD+ITD, the CPR indicated a doubling of the cerebral blood after a few minutes of the CPR process as well as showing increased CerPP as was already revealed in the previous research.

The basic mechanisms of gain underpinning head-up CPR are the utilization of the gravity to improve venous drainage from the cerebral venous and the brain as well as the benefits of paravertebral venous plexus; hence, reducing ICP and increasing chances of the forward flow of the blood (Paulussen et al., 2015). The other benefit is agued to the idea of reducing the pressure that is transmitted to the brain through both the arterial vasculature and the venous during CPR process; thereby, lowering concussive damage with compression (Lurie et al., 2019). The other mechanism includes the redistribution of the flow of blood via the lung in a way that is the same as what happens when a patient suffering from heart failure sits upright.

It is worth noting that studies which are based on animal’s head-up CPR are usually relying on the circulatory adjuncts during CPR performance, including the use of ITD-16 for driving the blood upward which maintain sufficient blood pressure in the arteries during recovery (Putzer et al., 2018). Notably, when the head-up standard CPR is conducted, the cerebral perfusion pressure during restoration has always been recorded at approximately 7 to 10 per cent of the baseline value of the CerPP, relative to when head-up CPR process with the circulatory adjuncts of ACD+ITD CPR (Lurie et al., 2019). Research has also considered other critical process for head-up CPR, including the application of caution and elevating the entire body for a longer duration, as the blood may pool in the lower extremity; and conducting CPR flat before the elevation that also causes cardio-cerebral circuit. Additionally, the outcomes of the higher CerPP and lower ICP during head-up CPR has perpetually been demonstrated in the human cadaver model. A further study has also concentrated on the optimum head-up CPR and timing of the thorax and head elevation.

Physiology

The standard CPR is often conducted using a pair of hands; the intrathoracic pressure is increased, chests are compressed, and the heart is squeezed between the spine and the sternum. For the compression, the pressure is increased both in the right arteries and the aorta, while the pressure in the right arterial is usually higher compared to the pressure in the left side (Putzer et al., 2018). The blood is pushed from the non-beating heart towards the brain and the coronary arteries and the rest of the body due to the existence of one-way valves in the heart as well as because of the difference in pressure between the thoracic and non-thoracic areas. In the last decade, studies have put more interest in the impact of increasing the intrathoracic pressure on ICP at the compression phase. The increase of the intracranial pressure causes an increase in the cerebral perfusion resistance (Lurie et al., 2019). Therefore, it is perceived that the decrease and the increase of the ICP during CPR is subjected to changes that occur in the intrathoracic pressure which are transduced through the spinal fluid and the paravertebral venous to the intracranial section.

More importantly, the increase in the intracranial pressure depends on every positive pressure in the ventilation. It is worth noting that the right atrial, pulmonary artery and the right ventricle pressure increases in parallel with every compression (Paulussen et al., 2015). Additionally, in the process of CPR the perfusion pressure at the coronary artery is computed as the difference between the pressure in the right side and the pressure in the aorta, that is, the increased pressure in the right side during the performance of standard CPR reduces the coronary perfusion pressure.

Notably, the physiology decompression during CPR is usually complex, and its necessity during the process has been properly understood recently. During this stage, the heart is only refilled after it being emptied during the previous compression phase. Such a process of refilling is vastly inefficient when conducting CPR process, especially when performing the standard CPR and the chest wall can only recoil to release force that can draw the blood back to the right side of the heart. Such results can be more accentuated in patients who suffer from broken ribs. Similarly, during the decompression period, the intracranial pressure is reduced. Whenever the chest wall recoils, the pressure reduces depending on the equivalent pressure, which also increases ICP at the decompression stage. More fundamentally, the changes which occur in the intracranial pressure during both the decompression and compression phases assist in the determination of the cerebral perfusion level when conducting CPR.

Figure 1: Compression Depth and Compression Rate

Methods and Materials

The study was conducted in Florida, which multiethnic and culturally diverse as well as extremes of socioeconomic status and ages. Even though there have been several logistical challenges and a reduced rate of bystander CPR performance in 2014, there has been the agency that could achieve successful resuscitation rate that was compared to the sates-wide out-of-hospital cardiac arrest (OOHCA) outcomes (Lurie et al., 2019). All the cases that occurred in the United States were treated by the agency, including patients with asystole who were also followed through 2014 up to 2016.

Regarding the methodology of the study, the head-up element was established by inserting a head case vessel under a stretcher in which the CPR device was devoted and secured. It caused a slight angle both for the CPR device and stretcher that elevated the chest and head of approximately 20 percent (King et al., 2017). Notably, the whole body remained flat, and the feet angle moved downward. Understandably, all the other that was offered during the whole analysis conformed to the generally accepted and prescribed guidelines following the American Heart Association (AHA). More importantly, the clinical strategies failed to change during the study, and specific procedural changes at the dispatch center did not take place up to the aftermath of the evaluation period.

Figure 2: Head-up and Torso-up

The execution of CPR bundle included head-up CPR that was achieved over several weeks as the training staffs finished many rounds in every station. Apart from the application of the standard chi-square for the statistical comparisons of mean results, in which p=0.01, the reports concerning the rates of resuscitation were generated and tracked throughout the period to identify any significant variation in the rates of resuscitation, as well as to record the possibility of any incremental impact that was realized during the period of protocol transition (King et al., 2017). The comparison outcomes were also recorded accordingly based on their full extremes of ranges during and after the transition of the head-up positioning process (Lurie et al., 2019). During the study, the privacy of the participants was maintained by the use of de-identified data and the conduct of the researchers. Also, the elevated CPR technique is referred to as the technologically-advanced method which is used for conducting device-assisted head-up CPR that involves elevating the head, thorax and the heart in a multi-level and timed sequence in conformity to the most suitable practice of resuscitation protocol.

Based on the materials, the ResQCPR system, which is derived from the ZOLL, can be used to integrate ITD-16 and the ACD CPR device. It is developed with the motive of delivering the intrathoracic pressure regulatory therapy at the time of cardiac arrest resuscitation (Illindala, 2016). Such therapy helps in regulating the amount of pressure in the chest to improve perfusion at the time when there is low blood flow in the body. In the case of the clinical trial, the use of this system increases the rate of survival by approximately 49% for the patient who undergoes conventional CPR. It is the device that has been identified to help increase the chances of the patient’s survival. Similarly, with the use of ResQPUMP device, the suction cup can be used on the chest that raises the thorax while the rescuer pulls up the holding handle (King et al., 2017). Subsequent lifting improves the i...