Kurt Bramer from Advanced CPR Solutions returns again this week to continue the series on Head-Up CPR and other promising sudden cardiac arrest treatments. There are three previous episodes in this series.

Elevated CPR Series Episode One

Elevated CPR Series Episode Two

Elevated CPR Series Episode Three

Elevated CPR Series Episode Five

After the severe weather update from disaster meteorologist Dan DePodwin, the Disaster Podcast team focuses on the science and physiology of Head-Up CPR. They ask why this approach provides for better protection of neurological function during a cardiac arrest. Dr. Joe Holley does an excellent job of describing the specific concepts of pressure gradients in blood flow to and from the heart during CPR in various patient positions.

Kurt outlines what he calls the Four Rules of Head-Up CPR that are essential components for successful resuscitation during cardiac arrest treatment. These rules come from Dr. Joanna Moore’s Editorial The Do’s and Don’ts of Head Up CPR:

1) Use of Suction Cup CPR and an ITD

2) A Priming Period is Needed

3) Cannot Lift the Patient Too High

4) You Cannot Lift the Patient Too Quickly

CARES Registry for Cardiac Arrest Stats

Follow up on more of these segments as we continue to look at the current research trends in future episodes and what is on the horizon for the future.

The episode was co-hosted by Sam Bradley and Jamie Davis.

Scroll down for Podcast Discussion Summary

Thank you as always to Paragon Medical Education Group for their long-term support of the Disaster Podcast. Dr. Joe Holley and the team at Paragon continue to provide excellent and customized disaster response training to jurisdictions around the U.S. and internationally as well.

Podcast Discussion Summary

The meeting began with a discussion about travel weather for the country and record cold in many parts of the upper midwest and northeast with Dan DePodwin.

The group then transitioned to their main topic, the physiology of CPR, with Dr. Joe Holley focusing our attention on the specific anatomy and process inside the body during CPR.

Kurt and Joe discussed the importance of adhering to the “four rules” of head-up CPR, which were derived from a published editorial by Dr. Moore. They emphasized that studies showing no improved outcomes often violate these rules, highlighting the significance of proper technique. Jamie Davis, the host of the Disaster Podcast, introduced the episode, which would focus on the science and physiology of elevated CPR, while Sam and Dan briefly discussed the early winter weather conditions across the United States.

The discussion focused on head-up CPR, a novel research advancement in resuscitation aimed at improving neurologic survival. Kurt explained its origins, highlighting a case study involving a ski hill cardiac arrest patient who survived due to an elevated head position, which was later recognized as a critical factor.

The conversation also touched on a study conducted in South Korea, where researchers developed a modified EMS stretcher to accommodate patients in high-rise buildings with small elevators, leading to the question of the optimal CPR position. Initial findings from animal studies suggested that a head-up position could reduce intracranial pressure, potentially improving outcomes during CPR.

Joe explained the physiology of CPR, focusing on how differences in pressure inside the body create blood flow. He described how chest compressions increase intrathoracic pressure, pushing blood towards the brain and other areas of lower pressure. He emphasized that over-ventilation and incomplete chest recoil can be detrimental during CPR, as they prevent blood from flowing back into the heart. He also noted that patients who exhibit “guppy breathing” during resuscitation have a better chance of successful resuscitation.

Joe explained the physiology of blood flow during CPR, focusing on the importance of preload and the manipulation of pressure differences between the thoracic cavity and the brain. He described how the ITD16 device creates a vacuum in the chest to enhance blood flow to the brain and reduce intracranial pressure. Joe also discussed the concept of “head-up CPR,” which combines enhanced vacuum with gravity assistance to improve blood flow and neuroprotective outcomes.

Sam and Kurt discussed the importance of using proper equipment and techniques for head-up CPR, as outlined by Dr. Joanna Moore’s “four rules.” Kurt emphasized that suction cup CPR in conjunction with an ITD or rescue pod is crucial for effective and safe head-up CPR.

He also stressed the need for a priming period, avoiding excessive head elevation, and slow head-up positioning to prevent blood from draining from the head faster than CPR can pump it back in. Kurt noted that studies claiming head-up CPR doesn’t work often violate these rules, highlighting the significance of adhering to the correct procedures.

The team discussed the importance of proper technique in head-up CPR, emphasizing that it requires a bundled care approach with specific parameters to be effective. Joe and Kurt shared a case study of a retired fire chief who successfully underwent head-up CPR, highlighting the potential benefits of this novel approach. The discussion also touched on the concept of using a combination of therapies in resuscitation, similar to the drug cocktail approach used in treating HIV.

The meeting focused on sharing and discussing remarkable cases of successful CPR, particularly highlighting the concept of “head-up” CPR, which has shown improved outcomes. Kurt and Joe shared several stories of patients who experienced significant neurologic recoveries after cardiac arrests, with survival rates and recovery rates significantly higher than national averages. The discussion emphasized the potential of advanced CPR techniques to improve survival and neurologic outcomes, with Joe noting that two of his services have seen similar success rates.

The group the role of specialized training, with Jamie highlighting the sponsorship of the Disaster Podcast by Paragon Medical Education Group.

Catch the full episode using the player above or on your favorite podcast platform, and don’t forget to subscribe to the Disaster Podcast for weekly insights from leaders in disaster response and research!