Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial.

Autor: Azeli Y; Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain. youcefazeli@gencat.cat.; Emergency Department, Sant Joan University Hospital, Reus, Spain. youcefazeli@gencat.cat.; Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain. youcefazeli@gencat.cat., Bardají A; Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.; Cardiology Department, Joan XXIII, University Hospital, Tarragona, Spain.; Universitat Rovira i Virgili, Tarragona, Spain., Barbería E; Universitat Rovira i Virgili, Tarragona, Spain.; Pathology Service, Institute of Legal Medicine and Forensic Sciences of Catalonia, Tarragona, Spain., Lopez-Madrid V; Emergency Department, Sant Joan University Hospital, Reus, Spain., Bladé-Creixenti J; Atenció Primaria, Institut Català de la Salut, Tarragona, Spain., Fernández-Sender L; Llevant Clinic Unit, Santa Tecla Hospital, Tarragona, Spain., Bonet G; Cardiology Department, Joan XXIII, University Hospital, Tarragona, Spain., Rica E; Department de Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain., Álvarez S; Department de Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain., Fernández A; Departament d'Enginyeria Química, Universitat Rovira i Virgili, Tarragona, Spain., Axelsson C; Center of Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden., Jiménez-Herrera MF; Department of Nursing, Universitat Rovira i Virgili, Tarragona, Spain.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2021 May 25; Vol. 25 (1), pp. 176. Date of Electronic Publication: 2021 May 25.
DOI: 10.1186/s13054-021-03593-7
Abstrakt: Background: There are data suggesting that passive leg raising (PLR) improves hemodynamics during cardiopulmonary resuscitation (CPR). This trial aimed to determine the effectiveness and safety of PLR during CPR in out-of-hospital cardiac arrest (OHCA).
Methods: We conducted a randomized controlled trial with blinded assessment of the outcomes that assigned adults OHCA to be treated with PLR or in the flat position. The trial was conducted in the Camp de Tarragona region. The main end point was survival to hospital discharge with good neurological outcome defined as cerebral performance category (CPC 1-2). To study possible adverse effects, we assessed the presence of pulmonary complications on the first chest X-rays, brain edema on the computerized tomography (CT) in survivors and brain and lungs weights from autopsies in non-survivors.
Results: In total, 588 randomized cases were included, 301 were treated with PLR and 287 were controls. Overall, 67.8% were men and the median age was 72 (IQR 60-82) years. At hospital discharge, 3.3% in the PLR group and 3.5% in the control group were alive with CPC 1-2 (OR 0.9; 95% CI 0.4-2.3, p = 0.91). No significant differences in survival at hospital admission were found in all patients (OR 1.0; 95% CI 0.7-1.6, p = 0.95) and among patients with an initial shockable rhythm (OR 1.7; 95% CI 0.8-3.4, p = 0.15). There were no differences in pulmonary complication rates in chest X-rays [7 (25.9%) vs 5 (17.9%), p = 0.47] and brain edema on CT [5 (29.4%) vs 10 (32.6%), p = 0.84]. There were no differences in lung weight [1223 mg (IQR 909-1500) vs 1239 mg (IQR 900-1507), p = 0.82] or brain weight [1352 mg (IQR 1227-1457) vs 1380 mg (IQR 1255-1470), p = 0.43] among the 106 autopsies performed.
Conclusion: In this trial, PLR during CPR did not improve survival to hospital discharge with CPC 1-2. No evidence of adverse effects has been found. Clinical trial registration ClinicalTrials.gov: NCT01952197, registration date: September 27, 2013, https://clinicaltrials.gov/ct2/show/NCT01952197 .
Databáze: MEDLINE
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