title: The effect of resuscitation position on cerebral and coronary perfusion pressure during mechanical cardiopulmonary resuscitation in porcine cardiac arrest model.
abstract: It is unknown whether patient position is associated with the optimal cerebral (CePP) and coronary (CoPP) perfusion pressure.
  
  
  
  This study utilized a randomized experimental design and anesthetized, intubated and paralyzed female pigs (n=12) (mean 42, SD 3kg). After 6min of untreated ventricular fibrillation, mechanical CPR with was performed for 3min in 0° supine position. The CPR was then performed for 5min in a position randomly assigned to either 1) head-up tilt (HUT) by three angles (30°, 45°, or 60°) or 2) head-down tilt (HDT) by three angles (30°, 45°, or 60°) and at 3) supine position between HUT and HDT positions. 4 Pigs were assigned to each angle of HUT or HDT position and 12 pigs were assigned to supine position. CePPs and CoPPs were measured and compared using MIXED procedure with pig as a random effect among angles and compared between angles with Tukey post-hoc analysis.
  
  
  
  With 60°, 45°, 30° head-down, 0° (supine), and 30°, 45°, 60° head-up positioning, mean(SD) CePPs increased consistently as follows: 2.4(0.4), 9.3(1.6), 16.5(1.6), 27.0(1.5), 35.1(0.4), 39.4(0.6), and 39.9(0.3) mmHg, respectively. CoPPs were followings according to same angle: 12.9(2.5), 13.3(2.5), 12.8(0.4), 18.1(0.7), 30.3(0.4), 24.1(0.6), and 26.5(0.9) mmHg, respectively. The CePPs were peak at HUT(45°) and HUT(60°), but CoPP was peak in HUT(30°) and higher than HUT(45°) and HUT(60°).
  
  
  
  Cerebral perfusion pressure during mechanical CPR were similar and highest in the HUT(45° and 60°) positions whereas the peak coronary perfusion pressure was observed with HUT(30°).
authors.affiliation: Department of Emergency Medicine, Gyeongsang National University Hospital, Republic of Korea. Electronic address: emkity@gmail.com.
authors.forename: Taeyun
authors.initials: T
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea. Electronic address: shinsangdo@gmail.com.
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea. Electronic address: skciva@gmail.com.
authors.forename: Kyoung Jun
authors.initials: KJ
authors.lastname: Song
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea. Electronic address: parkyongjoo@icloud.com.
authors.forename: Yong Joo
authors.initials: YJ
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, Republic of Korea. Electronic address: oriryu@hanmail.net.
authors.forename: Hyun Ho
authors.initials: HH
authors.lastname: Ryu
authors.affiliation: Department of Emergency Medicine, University Hospital of Grenoble, France. Electronic address: gdebaty@gmail.com.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Debaty
authors.affiliation: Department of Emergency Medicine, University of Minnesota, USA. Electronic address: keithlurie@icloud.com.
authors.forename: Keith
authors.initials: K
authors.lastname: Lurie
authors.affiliation: Department of Emergency Medicine, Seoul National University Boramae Medical Center, Republic of Korea. Electronic address: emkjhong@gmail.com.
authors.forename: Ki Jeong
authors.initials: KJ
authors.lastname: Hong
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002560:Cerebrovascular Circulation; D003326:Coronary Circulation; D004195:Disease Models, Animal; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D056888:Patient Positioning / Q000379:methods*; D055420:Perfusion Imaging / Q000379:methods; D013552:Swine; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications
keywords: Cardiopulmonary resuscitation; Cerebral perfusion pressure; Coronary perfusion pressure; Position; Swine