The impact of head and thorax elevation on respiratory mechanics during cardiopulmonary resuscitation: a multi-model study
Abstract
Background The impact on ventilation of head and thorax elevation (HTE) and the use of an impedance threshold device (ITD) during cardiopulmonary resuscitation (CPR) remains poorly understood. The aim was to describe the impact on ventilation and absolute lung volumes of HTE vs. horizontal (FLAT) positions, with or without ITD use, across multiple cardiac arrest experimental models. Methods This was a cross-over experimental trial conducted using three models: pigs, Thiel-embalmed cadavers, and thawed fresh-frozen cadavers. Two protocols were applied in a 1:1 randomized order: FLAT and HTE positions first, with or without ITD. Primary outcome was the calculation of absolute loss of lung volume (Vloss) below the functional residual capacity. Airway opening pressure (AOP) and respiratory system compliance (Crs) were also calculated, both assessed before CPR initiation. Linear mixed models were used for statistical analysis. Results Eight pigs and eight cadavers (4 Thiel, 4 fresh-frozen) were included In the linear mixed model, there was a significant difference for Vloss for FLAT vs. HTE (p = 0.05) with an estimate of 43.9 mL (95%CI: 1.41; 86.4), while no significant difference was observed comparing ITD vs. no-ITD (p = 0.28) with an estimate of 23.6 mL (95%CI: -18.9; 66.1). In cadavers, AOP was not significantly different: HTE: 5.9 (2.9–10.3) vs. FLAT: 8.1 (6.4–11.5) cmH 2 O (p=0.07). Crs was not significantly different: HTE: 30.9 (21.3–34.4) vs. FLAT: 26.2 (24.0–30.3) mL/cmH 2 O (p=0.2). Conclusions In this multi-model study, HTE during CPR limits loss of lung volume below functional residual capacity.
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BibTeX
@article{segond2026impact,
title = {{The impact of head and thorax elevation on respiratory mechanics during cardiopulmonary resuscitation: a multi-model study}},
author = {Nicolas Segond and Arnaud Lesimple and Lilian Barlet and Laura Polard and Fanny Lidouren and Emmanuel Charbonney and Dominique Savary and François Morin and Alexandre Bellier and Renaud Tissier and Jean-Christophe Richard and Guillaume Debaty},
journal = {Resuscitation Plus},
year = {2026},
month = nov,
doi = {10.1016/j.resplu.2026.101464},
url = {https://hal.science/hal-05851923v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - The impact of head and thorax elevation on respiratory mechanics during cardiopulmonary resuscitation: a multi-model study
AU - Nicolas Segond
AU - Arnaud Lesimple
AU - Lilian Barlet
AU - Laura Polard
AU - Fanny Lidouren
AU - Emmanuel Charbonney
AU - Dominique Savary
AU - François Morin
AU - Alexandre Bellier
AU - Renaud Tissier
AU - Jean-Christophe Richard
AU - Guillaume Debaty
PY - 2026
DA - 2026/11/04
JO - Resuscitation Plus
DO - 10.1016/j.resplu.2026.101464
UR - https://hal.science/hal-05851923v1
AB - Background The impact on ventilation of head and thorax elevation (HTE) and the use of an impedance threshold device (ITD) during cardiopulmonary resuscitation (CPR) remains poorly understood. The aim was to describe the impact on ventilation and absolute lung volumes of HTE vs. horizontal (FLAT) positions, with or without ITD use, across multiple cardiac arrest experimental models. Methods This was a cross-over experimental trial conducted using three models: pigs, Thiel-embalmed cadavers, and thawed fresh-frozen cadavers. Two protocols were applied in a 1:1 randomized order: FLAT and HTE positions first, with or without ITD. Primary outcome was the calculation of absolute loss of lung volume (Vloss) below the functional residual capacity. Airway opening pressure (AOP) and respiratory system compliance (Crs) were also calculated, both assessed before CPR initiation. Linear mixed models were used for statistical analysis. Results Eight pigs and eight cadavers (4 Thiel, 4 fresh-frozen) were included In the linear mixed model, there was a significant difference for Vloss for FLAT vs. HTE (p = 0.05) with an estimate of 43.9 mL (95%CI: 1.41; 86.4), while no significant difference was observed comparing ITD vs. no-ITD (p = 0.28) with an estimate of 23.6 mL (95%CI: -18.9; 66.1). In cadavers, AOP was not significantly different: HTE: 5.9 (2.9–10.3) vs. FLAT: 8.1 (6.4–11.5) cmH 2 O (p=0.07). Crs was not significantly different: HTE: 30.9 (21.3–34.4) vs. FLAT: 26.2 (24.0–30.3) mL/cmH 2 O (p=0.2). Conclusions In this multi-model study, HTE during CPR limits loss of lung volume below functional residual capacity.
SN - 2666-5204
ER -