EleGARD™ Training Materials & Support

The EleGARDTM Patient Positioning System (EleGARD) is a cardiopulmonary board which may elevate a patient’s head and thorax: including during airway management; during manual CPR, manual CPR adjuncts, CPR with the LUCAS® Chest Compression System or ARM XR Automated Chest Compressor; and patient transport. EleGARD is indicated for adults only when used with the LUCAS Chest Compression System or the ARM XR Automated Chest Compressor. When not used with an automated compression system, EleGARD can be used for adults and children, not including infants and neonates.

The EleGARD should not be used:

• • If the patient weighs more than 350 lbs./159 kg. (IFU, p. 5)
  • Anytime the patient cannot be correctly or safely positioned on the EleGARD (IFU, p. 5)
  • In standing water or snow (IFU, p. 12).

The maximum elevation is not measured as an angle, but as a height. The Fully Raised thoracic elevation is approximately 8.5 cm/3.4 in. from supine, and the Fully Raised head elevation is approximately 25.3 cm/10 in. from supine (IFU, p. 25).

• Each light indicates 30% of the charge capacity (IFU, p. 11):
• No lights – less than 30% charge capacity
• One light – at least 30% charge capacity
• Two lights – at least 60% charge capacity
• Three lights – at least 90% charge capacity.

When the EleGARD System is in use, the battery lights cascade upward once the Up Button (#3) has been pressed to indicate elevation is in progress.

If the battery fails during use, the EleGARD System will remain in its current position. Replace the expired battery with a charged battery, press the Power button to turn the EleGARD on, then press the appropriate up or down button to continue the elevation sequence.

• This button stops and/or resets the timer.
• A single quick push stops the timer.
• Holding this button for 3 seconds will reset the timer.

• If the patient is wearing a cervical collar or has a bullneck (IFU, p. 7, p. 18).
• Patients with spondylosis (stiff neck) may also benefit from removal of the neck cushion.

• Timed 2:00 minute period immediately preceding the elevation of head and thorax with continuous high-quality compressions using circulatory adjuncts to help ensure blood flow through the entire cardio-cerebral circuit: heart, lungs, brain.  This period should not begin until there is a ‘sealed’ circuit (sealed airway with ITD) and there is a suction cupped based CPR in process. Because nothing should interrupt the priming period, it may also be necessary to perform the rhythm check/intervention before starting this timed period.

• Follow local protocol. 
• If providers ‘lose the ‘seal’ on the airway for more than 10-15 seconds you could lose your “prime.” Consider lowering the head if your ITD comes off or you lose the seal on the airway: tube dislodged or mask seal breaks.
• Pre-clinical research has shown that post-ROSC patients with an adequate MAP may benefit from elevation of the head/thorax (Duhem, Resuscitation, 2021).
• Some agencies may choose to treat the post-ROSC patient like a traumatic brain injured patient. Consider lowering the head after ROSC only if MAP<65 or BP<90, leaving the patient in the EleGARD System in the lowest position. Always follow medical direction/local protocol.

• Moore, 2022 reports that improvements were seen in hemodynamics including EtCO2 with agencies that use HUP products and process. 
• Debaty reports nearly normal EtCO2 values in patients treated with HUP-CPR (Debaty et al. SAEM 2023).
•  If more blood is consistently circulating, there may not be a rapid rise in EtCO2 that has traditionally been an indicator of ROSC. Rather, there could be a more consistently elevated EtCO2.
• With improved perfusion, other signs of life could be evident without ROSC.  These could include eye opening, extremity movement, opening and closing of mouth, etc.  If these occur, reassess the patient, be prepared to continue BLS/ALS care.

• Yes, you can, but “priming” is suggested, based upon preclinical studies, before further elevating the head and thorax on the EleGARD.
• The EleGARD System is indicated for airway management (EleGARD System Instructions for Use: Section 2. Introduction) and may help with airway placement.
• Also, rapid deployment of the HUP-CPR bundle including the EleGARD is correlated (Moore, Resuscitation, 2022) to improved neurologically intact survival from sudden cardiac arrest.

• Fine adjustment of head up and down to maintain sniffing position.  (EleGARD System Instructions for Use: Section 6. Using the EleGARD System).
• You should not try to lift the patient’s head or body by lifting the red handle as that may break the EleGARD.

• Consider a fine adjustment of the head with the red handle to create more space.
• If this does not work, you could consider lowering the EleGARD (press the grey down button).

• The neck support can be removed. (EleGARD System Instructions for Use: Section 6. Using the EleGARD System.)

Mechanically, the elevation will start once you press the #3 button.  This can be done before (or after) 2:00 minutes.  Research does not support starting the elevation before 2:00 minutes of priming. (Rojas, Resuscitation, 2020)

This provides the user the ability to adjust based upon local protocols.

If this is not intentional, you can press the (red) stop button, lower the head (grey button), and restart the timer/period of priming based upon your protocol.

If starting elevation at 2:00 minutes is local protocol, press as soon as you recognize that there has been at least 2:00 minutes of priming. Research has shown that just placing into the EleGARD System reduces intracranial pressure to some degree and start some benefits. (Rojas, Resuscitation, 2020)

It is not a factor of angle but of height. At the final heights, the thorax is raised approximately 8 cm from supine and the head is approximately 22cm from supine. (It is “approximately’” as every patient’s anatomy is slightly different.)

Patient Positioning
Approximate measurements above ground level:

No. The EleGARD System must be placed before attaching the mCPR.

No. The latching mechanism and the guides for the CPR plate on the EleGARD System do not allow for the separation of the mCPR from the EleGARD System while the patient is in the EleGARD System.

• The EleGARD System is designed to work with the included LUCAS® 3 CPR backplate or the ARM XR backplate. 
• The LUCAS® 2 device works with the LUCAS® 3 backplate, which comes  with the EleGARD.
• The radio translucent plate does not have the holes in the plate to help guide and ensure secure placement.  This plate will not secure onto the EleGARD System.

DO NOT spray the EleGARD System directly.  Use a cleaning solution on a cloth and wipe down.  (EleGARD System Instructions for Use: Section 7. Preparation for next use)

 It can be used without the cover.  But it is not recommended.  Using the cover could make cleaning and disinfecting quicker and easier. 

• Be sure to follow your protocol.
• Sudden cardiac arrest patients are often transported only after ROSC. If the patient has sustained ROSC, you should transfer to the ED cot using the soft stretcher with all equipment left in place. After transfer to ED cot, remove the upper part of the mCPR, safely lift the patient’s torso, remove the EleGARD System from a position at the head of the bed and lower the patient back to the bed.  According to preclinical work by Duhem et al. (2022) you may consider leaving the ED cot elevated 15-30° just as you would for any brain injured patient, as long as they have an adequate MAP. Always be sure to follow medical direction/local protocol.
• Consider what will happen with the patient (and equipment) if the patient will be transferred to the cath lab. If the equipment will be used by the receiving facility for an extended period, you may need to notify your supervisor for further direction. Consider creating a plan for extended ‘out of service’ time for personnel/equipment to support hospital continuance of the neuroprotective protocol.
• Remember: You are the ‘expert.’ Offer your help/guidance for use of device at the receiving hospital.  Do not be afraid to offer guidance and answer questions in the resuscitation room, especially if you encounter someone that has limited knowledge of the EleGARD System and the science of head up position for resuscitation.
• Efforts should be made to get information to the receiving hospitals about your use of the EleGARD System including the science of head up position for resuscitation before initial deployment.
• Know that not everyone gets all new information in a timely manner.  You may encounter someone that is not familiar with this new protocol, and you may need to share your knowledge with them.
• You should have access to written materials to share with the hospital.

Be sure to accurately document time of placement of the EleGARD

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