In this episode the guys speak with Dr. Ross Campensa, EMS Medical Director from the Aultman hospital system to discuss his journey with heads up CPR (branded ElevatedCPR) in his EMS systems. UH and Aultman have a EMS partnership to develop a Health Delivery System, pooling the resources of both agencies. 

The Technique

The ElevatedCPR method is a technologically-advanced technique for performing device-assisted head up CPR that incorporates raising the head, heart, and thorax in a multi-level elevation, in a timed sequence, in conjunction with best practice resuscitation protocols.

The timing and elevation sequence for the ElevatedCPR method are scientifically based on preclinical studies which have shown the benefits of a sequence that includes a two minute period of high quality CPR with active compression / decompression (ACD) and an impedance threshold device (ITD) or mechanical CPR and  and ITD. This begins with the patient in a low supine position followed by a slow progressive rise of 6cm/min over two minutes to a head height of 22cm and a thorax of 8cm which has been shown to improve cerebral perfusion and coronary perfusion.

The History

In the early 2010’s, Korean clinicians faced the challenge of extracting cardiac arrest victims from the small elevators pervasive in Asian apartment complexes, and determined that a change in patient positioning might provide a solution. The physicians were working with a patient stretcher that could be tilted to fit into the elevator without stopping CPR and recommended tilting the head of the patient down during extrication, based on a theory that blood draining from the lower trunk and legs from the force of gravity would increase blood flow to the heart and brain and produce better outcomes.

In 2014, Keith Lurie, M.D., founder of AdvancedCPR Solutions and a globally-respected expert and researcher in resuscitation, and his team analyzed the impact of head down positioning on patient physiology and hemodynamics. Dr. Lurie and his team used their proven cardiac arrest animal model, monitoring systems and an automated CPR device with a tilt table that could tilt the entire body up or down.

They first replicated the Korean recommendation for head down CPR and saw an immediate, profound and dangerous increase in intracranial pressure and a corresponding decrease in cerebral perfusion pressure – exactly the opposite of what was expected and needed.

The team decided to investigate what would happen if the patient were tilted the other direction – into a head up or elevated position. Surprisingly, the exact opposite of what was expected occurred – both the intracranial pressure fell and cerebral perfusion pressure increased by statistically significant levels. Their research into head up positioning and device-assisted head up CPR continued forward and is the basis for the ElevatedCPR method. Lurie and his team have published a number of scientific papers about the ElevatedCPR method and its potential benefits as an additional recommendation to address sudden cardiac arrest.

The ITD's and ACD CPR Devices

Intrathoracic Pressure Regulation (IPR) Devices

IPR therapy enhances negative intrathoracic pressure within the chest, which improves preload, cardiac output and lowers intracranial pressure (ICP) to provide better perfusion to the brain and vital organs. IPR therapy is currently delivered with ZOLL's ResQPOD impedance threshold device (ITD) and the ResQCPR® System.

ResQPOD ITD

The ResQPOD ITD is a simple, non-invasive device that delivers IPR therapy during basic or advanced life support CPR to enhance perfusion. When used with high-quality CPR, the ResQPOD ITD has been shown in clinical studies to improve survival by 25% or more.

ResQCPR System

The ResQCPR System, consisting of the ResQPOD ITD and the ResQPUMP ACD-CPR device, takes the perfusion enhancing-power of the ResQPOD ITD to the next level. The ResQPUMP allows the rescuer to perform active compression-decompression CPR (ACD-CPR), which promotes complete and active chest recoil. In a major clinical study, the ResQCPR System showed a 49% increase in one-year survival from cardiac arrest. 

The EleGARD Patient Positioning System

The EleGARD System is an FDA-cleared and CE-marked patient positioning device and cardiopulmonary board that can elevate a patient’s head and thorax during airway management; manual CPR, manual CPR adjuncts, CPR with the LUCAS® Chest Compression System and patient transport.

The EleGARD System is the only device that precisely and consistently positions the patient for CPR and airway management and raises the patient into multi-level elevation positioning that could support the practice of the ElevatedCPR method in both pre-hospital and hospital settings.

Early user evaluations show a significant benefit when using the ElevatedCPR method with the EleGARD. Overall data shows:

-60% ROSC in VT/VF (Shockable patients)
-46% ROSC in PEA (non-shockable patients)
-26% ROSC in Asystole (non-shockable patients)