Elevating the feet during CPR?

[akroeze]

Random thought just occurred to me while I was laying down which makes me think it may be wrong but I'll ask anyway. Why don't we elevate the feet during CPR? Would this not increase the amount of blood in the core?

[Ridryder 911]

This is why ..

The Trendelenburg Position: Another EMS Myth

By Bryan E. Bledsoe, DO, FACEP

MERGINET—One of my most-requested conference talks is entitled Myths of Modern EMS. It also corresponds to a series that I wrote for EMS Magazine in 2003. In that lecture, I review numerous EMS practices and the science, or lack thereof, behind them. It stimulates discussion and, as I had hoped, has stimulated some research. Now, I have another EMS myth I can add to my repertoire: the Trendelenburg position improves circulation in cases of shock.

Researchers at the University of Southern California Keck School of Medicine performed a retrospective review of the literature pertaining to use of the Trendelenburg position in shock. They found several studies on the maneuver. One compared six hypotensive patients in clinical shock to five normotensive patients. In nine of the 11 patients, the Trendelenburg position was ineffective, causing reductions in systolic, diastolic and mean arterial pressure. They also found that the abdominal viscera moved up onto the diaphragm, restricting respiratory volumes when patients were placed in the Trendelenburg position. Another study looked at oxygen transport in eight hypovolemic postoperative patients placed into the Trendelenburg position. While the position seemed to increase blood pressure, it did not increase cardiac output. Another researcher studied the effect of the Trendelenburg position on blood distribution and found that only 1.8 percent of the total blood volume was displaced centrally. In a relatively large study of 76 critically ill patients (61 normotensive and 15 hypotensive), they found no change in pre-load or mean arterial pressure for normotensive patients. In normotensive patients, they found a slight increase in cardiac output. However, for hypotensive patients, there was no increase in pre-load or mean arterial pressure. In these patients they found that cardiac output actually diminished—a detrimental effect.

In summary, the Trendelenburg offers no benefit to hypotensive patients. Like the MAST/PASG, another long-held belief can be abandoned as EMS becomes more evidence based.

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[akroeze]

Interesting, but in truth it doesn't answer my question with the information and practices of today.

In the field today, it is practice to elevate the feet for shock. We do that based on the (apparently flawed) principal that it will shunt blood to the core of the body. So why is it acceptable to do that when they have a beating heart but not when they don't?

[Ridryder 911]

Because most education that teaches cardiac care knows that trendlenburg is a myth... Without perfusion all that would occur is slight venous pooling. ....short and simple.

R/R 911

[AnthonyM83]

Do any of those studies specifically address cranial blood flow?

Does it still have a use for correcting light-headedness and preventing fainting?

I know modified Trendelenberg has definitely made me feel immediately better in such situations.

[Nate]

Another study looked at oxygen transport in eight hypovolemic postoperative patients placed into the Trendelenburg position. While the position seemed to increase blood pressure, it did not increase cardiac output.

That right there about sums it up.

[jmac]

ok,

correct me if i am wrong but i learned that the trandelenburg is feet up head down, after reading the question in the first post, it has nothing to do with the trendelenbusrg ???

feet up for shock is to bring the volume from the legs into the torso, now i have raised god only knows how many legs to increase BP...and it works...fact..and i have seen it with my own eyes and on my cuff, the whole route of elevating BP in compressions is now at the moment going over to automated compressers, a machine that builds up BP by compressions..i am still sceptical about this..but raising the legs may be a good idea but i deffinitly dont want to do resus on a pt in the trendelenburg,

keep safe.

[als_medic_uk]

You don't elevate legs, because you want to return venous flow, CPR isn't just about arterial blood circulation, I remember some research into the prone position and its increased effectiveness in CPR [for both v and a return] however, my Journals seem to had excluded this, although knowing me, I have misplaced it.

Regards.

[Ridryder 911]

Why don't we elevate the feet during CPR?

Hmm.. that is the Trendelenburg position most people use. As the studies shows it DOES NOT WORK. when you are alive, why would it work you are dead ?... The most you could get is some venous pooling... c'mon this is basic pathophysiology. Without a circulating and brain function (thus no autonomic function.. no release of alpha stimulation then decreasing angiotension I and II) pre & post sphincters dilate causing massive pooling in the central pool ... thus pale, cold skin... Raising the feet 6 - 10 inches is not going to cause nothing except more pale toes... It does not cause any change in pre-load and after load short and simple. This is just one of the studies that was performed. At one time Emergency Cardiac Committee had considered placing trendlenburg into the standards and found out it was just a myth

R/R 911

[AnthonyM83]

Once again, what do the myth studies say about modified Trendelenburg in regards to stopping light headedness and preventing fainting after drop in BP...which is what I was taught the main purpose of it was...not cardiac output stuff.