Head-Up CPR

Insights

Head-up cardiopulmonary resuscitation (CPR) is an emerging strategy that involves gradual elevation of the head after CPR has been initiated, and it has been shown in cadaver and animal studies to improve cerebral blood flow and cerebral perfusion pressure when combined with active compression-decompression plus impedance threshold devices. In adult cardiac arrest, head-up CPR has been studied as part of a bundle of care using mechanical CPR, an automated head/thorax-up positioning device and an impedance threshold device. Evidence in humans is very limited and low certainty, mostly observational or feasibility-based studies, with no large randomized controlled trials showing improved survival or neurologically intact survival. The specific equipment required—active compression-decompression CPR plus an impedance threshold device to optimize venous return—is not widely available, and field implementation is logistically challenging. Elevation of the head before circulation is adequately established may reduce cerebral perfusion, rather than improve it. Additional clinical trials or high-quality evidence of the effect of head-up CPR or head-up CPR bundle is needed, including studies assessing the optimal angle and timing of head elevation. The Red Cross continues to recommend against the routine use of head-up CPR.