The Origin of ElevatedCPRTM Method.
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 new patient stretcher concept that could fit into the small elevator without stopping CPR. They developed a prototype that would elevate the legs straight up in the air while the torso and head of the patient was flat on the novel stretcher. In this way an automated device could be used while transporting the patient. They shared this idea with Keith Lurie, MD, AdvancedCPR’s founder and a globally-respected expert and researcher in resuscitation.
In 2014, Dr. Lurie and his team compared the physiologic impact of performing CPR when elevating the legs with the head down (Trendelenburg Position) versus elevating the heart and thorax with the legs down (Reverse Trendelenburg Position). They used a well-established 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 tested 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.
Next the team, including the physicians from Korea, investigated what would happen if the body was tilted the other direction – into a head up or elevated position. Both the intracranial pressure fell and cerebral perfusion pressure increased, and then the animals started to gasp spontaneously. These kinds of physiological changes had not been observed previously by Dr. Lurie or his colleagues.
Over the subsequent four years their research into head up positioning has continued. Dr. Lurie and his team discovered that the physiology is more complicated than anticipated and the potential to improve outcomes is much greater than originally anticipated. Their discoveries have become the basis for AdvancedCPR Solutions’ ElevatedCPRTM therapy. Lurie and his team have published a number of scientific papers about ElevatedCPR therapy and its potential benefits as an additional recommendation to a forward-thinking bundle of care to address sudden cardiac arrest. One of the most important aspects of these discoveries is that elevating the head and heart must be done in the correct manner in order to optimize benefits and minimize risks. There is an optimal sequence which, when followed, can result in near normal cerebral perfusion pressures in an animal model of prolonged cardiac arrest. For more details please read the Do’s and Don’ts of Head Up CPR by Moore et al.1