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Leg Raise in Cardiopulmonary Resuscitation

Sellers, William F. S. FRCA

doi: 10.1213/ANE.0000000000001520
Letters to the Editor: Letter to the Editor

Broadgate House, Great Easton, Leicestershire, United Kingdom,

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To the Editor

Passive leg raising during cardiopulmonary resuscitation (CPR) was not mentioned in the excellent review by Lurie et al.1 Passive leg raising is useful in simple fainting and has been found to improve carbon dioxide elimination in CPR.2 The first formal CPR guidelines advocated by the American Heart Association in 1974 included a statement that “elevation of the lower extremities may promote venous return and augment artificial circulation during external cardiac compression.” This was removed in 1992, and it is not in the 2015 guide.3 In this review is mention of a benefit of “head-up CPR in pigs” but detrimental “patient’s feet up and head down,” which reduces cerebral perfusion pressure and increases intracranial pressure. Would the reviewers please consider an addendum on passive leg raise during performance of CPR?

William F. S. Sellers, FRCABroadgate HouseGreat Easton, LeicestershireUnited

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1. Lurie KG, Nemergut EC, Yannopoulos D, Sweeney M. The physiology of cardiopulmonary resuscitation. Anesth Analg. 2016;122:767783.
2. Axelsson C, Holmberg S, Karlsson T, Axelsson AB, Herlitz J. Passive leg raising during cardiopulmonary resuscitation in out-of-hospital cardiac arrest—does it improve circulation and outcome? Resuscitation. 2010;81:16151620.
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