The overall goal of this application is to improve neurologically-intact survival rates after sudden cardiac arrest (SCA), the leading cause of death in adults in the US. Despite conventional (C) CPR, <10% of 300,000 pre-hospital and <30% of 300,000 in-hospital SCA patients in the US each year survive with favorable neurological function. We propose to develop and evaluate a novel comprehensive Head Up Position (HUP) cardiopulmonary resuscitation (CPR) System designed primarily to allow Basic Life Services (BLS) providers (a fire crew withoutparamedics) to rapidly deliver fully automated CPR, including for the first time, automated breath delivery andautomated and optimized full lift active compression decompression, to increase the likelihood of neurologicallyintact survival after SCA and increase crew safety. The proposal focuses on further developing and deliveringan innovative all-in-one HUP resuscitation system (HRS) for BLS teams based on our most recent breakthroughsin optimizing brain perfusion during SCA using controlled sequential elevation of the head and thorax combinedwith Active Compression Decompression (ACD) CPR and an impedance threshold device (ITD). Asdemonstrated in a well-accepted porcine SCA model, HUP CPR combined with full lift ACD CPR and an ITDuniquely harnesses gravity to enhance drainage of venous blood from the head and neck, lower intracranialpressure, and markedly increase systemic and cerebral blood flow and likelihood for neurologically-intactsurvival. The overall objectives of this application are also supported by new clinical data from a HUP CPRRegistry demonstrating this neuroprotective approach provides a striking benefit when deployed rapidly byEmergency Medical Services (EMS) first responders. Moreover, in resource-strapped EMS systems countrywidethere is a growing need to develop technology that minimizes the number of resources required to deliver highquality CPR that is best for patient outcomes and safer for rescue personnel. We propose to achieve thesecollective objectives by demonstrating that incorporation of 1) automated and integrated ACD CPR and 2)automated breath delivery into an easy to deploy and fully automated HUP CPR system, is feasible and safe forBLS providers, will reduce CPR personnel resource requirements, and most importantly, will optimize chancesfor neurologically intact survival after SCA. As such, the Specific Aims are: 1) Determine the optimal waveformduring HUP with full ACD CPR to optimize brain and heart blood flow and compare the optimized waveform witha LUCAS 3.1 waveform in a porcine survival study and 2) Design and prototype a functional HRS, an all-in-onedevice with integrated, optimized, and automated full ACD CPR and automated breath delivery.
Public Health Relevance Statement: Project Narrative The overall goal of this application is to improve neurologically-intact survival rates after sudden cardiac arrest (SCA). Still a leading cause of death, less than 10% of the more than 600,000 SCA patients in the US each year survive with favorable neurological function. Phase 1 funding will support the development of an optimal and integrated means to provide automated active compression decompression CPR to cardiac arrest victims in addition to automated breath delivery and controlled sequential elevation of the head and thorax to improve cerebral blood flow. This System is designed to be applied by first responders so that time to application of these life-saving technologies is shortened. These advances have the potential to increase survival with favorable neurological function in victims of SCA.
Project Terms: <21+ years old>
