LHP E79 - Head Up CPR – Not So FAST

The EMS Lighthouse Project

Show Notes:
EMS History is full of interventions we've rapidly adopted, often at great expense and with
disruption of existing processes, that later turned out to, how should I say this..... not work.
Want examples? MAST and high-volume crystalloids in trauma. Mechanical compression
devices, high-dose epinephrine, indiscriminate calcium administration in cardiac arrest. Do I
even need to mention backboards?
The next bright shiny thing promising to revolutionize cardiac arrest resuscitation is Head-Up
CPR. It's certainly expensive and disruptive, but does it improve outcomes? What is the
evidence?
Dr. Jarvis has thoughts. He goes deep on this topic, using a recent paper on Head-Up CPR to
discuss how he evaluates new interventions for adoption. Oh, and he has thoughts on science in
general.

Citations:
1. Moore JC, Pepe PE, Scheppke KA, Lick C, Duval S, Holley J, Salverda B, Jacobs M, Nystrom P,
Quinn R, et al.: Head and thorax elevation during cardiopulmonary resuscitation using
circulatory adjuncts is associated with improved survival. Resuscitation. 2022;October;179:9–
17.
2. Swaminathan A: Heads Up! There is No Association with Improved Outcomes for Head Up
CPR: Why We Must Read Past the Abstract.RebelEM. Available at https://rebelem.com/heads-
up-there-is-no-association-with-improved-outcomes-for-head-up-cpr-why-we-must-read-past-
the-abstract/.
3. Mohan M, Swaminathan AK: Heads Up! Data Dredging Coming Through: Heads Up
Cardiopulmonary Resuscitation Does Not Improve Outcomes. Annals of Emergency Medicine.
2023;February;81(2):244–5.
3. Jarvis J: Not so fast: More evidence needed in head-up CPR.ems1.com. Available at
https://www.ems1.com/ems-products/cpr-resuscitaCon/arCcles/not-so-fast-more-evidence-
needed-in-head-up-cpr-ZK2O7yt5eb8jryYm/. Accessed December 9, 2023.
4. Moore JC: Faster Cme to automated elevation of the head and thorax during
cardiopulmonary resuscitation increases the probability of return of spontaneous circulation.
ResuscitaCon. 2022;Jan(170):62–9.
5. Pepe PE, Scheppke KA, Antevy PM, Crowe RP, Millstone D, Coyle C, Prusansky C, Garay S, Ellis
R, Fowler RL, et al.: Confirming the Clinical Safety and Feasibility of a Bundled Methodology to
Improve Cardiopulmonary Resuscitation Involving a Head-Up/Torso-Up Chest Compression
Technique. Crit Care Med. 2019;March;47(3):449–55.
6. Metro Fire Chiefs: First-In Responders Providing Neuroprotective (“Heads-Up”) CPR as the
Standard of Care for Emergency Medical Services Systems.NFPA. Available at
https://www.nfpa.org/-/media/Files/Membership/member-secCons/Metro-Chiefs/Urban-Fire-
Forum/2023/UFF23_NPCPR-PosiCon-Statement.ashx. Accessed November 4, 2023.