• Johanna C Moore, Sue Duval, Charles Lick, Joseph Holley, Kenneth A Scheppke, Bayert Salverda, Carolina Rojas-Salvador, Michael Jacobs, Paul Nystrom, Ryan Quinn, Paul J Adams, Guillaume P Debaty, Mack Hutchison, Charles Mason, Eduardo Martinez, Steven Mason, Armando Clift, Peter Antevy, Charles Coyle, Eric Grizzard, Sebastian Garay, Keith G Lurie, and Paul E Pepe.
• Hennepin Healthcare, Hennepin Healthcare Research Institute, University of Minnesota, United States.
• Resuscitation. 2022 Jan 1; 170: 63-69.

ObjectivesResuscitation in the Head Up position improves outcomes in animals treated with active compression decompression cardiopulmonary resuscitation and an impedance threshold device (ACD + ITD CPR).We assessed impact of time to deployment of an automated Head Up position (AHUP) based bundle of care after out-of-hospital cardiac arrest on return of spontaneous circulation (ROSC).MethodsObservational data were analyzed from a patient registry. Patients received treatment with 1) ACD + and/or automated CPR 2) an ITD and 3) an AHUP device. Probability of ROSC (ROSCprob) from the 9-1-1 call to AHUP device placement was assessed with a restricted cubic spline model and linear regression.ResultsOf 11 sites, 6 recorded the interval from 9-1-1 to AHUP device (n = 227). ROSCprobfor all rhythms was 34%(77/227). Median age (range) was 66 years (19-101) and 68% men. TheROSCprobfor shockable rhythms was 47%(18/38). Minutes from 9-1-1 to AHUP device (median, range) varied between sites: 1) 6.4(4,15), 2) 8.0(5,19), 3) 9.9(4, 12), 4) 14.1(6, 36), 5) 15.9(6, 34), 6) 19.0(8, 38),(p = 0.0001).ROSCprobalso varied; 1) 55.1%(16/29), 2) 60%(3/5), 3) 50%(3/6), 4) 22.7%(17/75), 5) 26.4%(9/34), and 6) 37.1%(29/78), (p = 0.019). For all rhythms between 4 and 12 min (n = 85),ROSCprobdeclined 5.6% for every minute elapsed (p = 0.024). For shockable rhythms, between 6 and 15 min (n = 23),ROSCprobdeclined 9.0% for every minute elapsed (p = 0.006).ConclusionsFaster time to deployment of an AHUP based bundle of care is associated with higher incidence of ROSC. This must be considered when evaluating and implementing this bundle.Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.

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