Vol 7, No 1 (2022)
Original article
Published online: 2022-01-25

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Does the position of the body impact the return of spontaneous circulation and hospital survival in sudden cardiac arrest patients?

Klaudiusz A. Nadolny12, Dorota Zyśko3, Dariusz Boroń1, Jerzy R. Ładny4, Robert Gałązkowski5, Kamil Bujak6, Mariusz Gąsior6, Jacek Kubica7, Artur Fedorowski89, Richard Sutton810
Medical Research Journal 2022;7(1):10-16.


Introduction: Out-of-hospital cardiac arrest (OHCA) is a big medical problem.

Material and methods:
The aim of this study was to assess the occurrence of sitting position in victims of OHCA at the arrival of Emergency Medical Services (EMS) and examine whether maintaining a supine position until ambulance arrival impacts the return of spontaneous circulation (ROSC) and survival until hospital admission and discharge. The documentation of patients in the OHCA registry of part of Silesian Voivodeship 1–06.2018 was accessed and yielded 634 cases for analysis.

The sitting position was found in 41 (6.5%) patients. These patients were more frequently female: 46.3% vs 30.6%, and older: 74.0 (57.9–82.0) vs 67.7 (54.9–75.8) and less frequently received cardiopulmonary resuscitation (CPR) from bystanders: 7.3% vs 63.6%, while ROSC was found with similar frequency: 34.2% vs 34.1%, survival until hospital admission in ROSC subgroups was lower in those in a sitting position than in a lying position: 50% vs 75.5%. None patients who were found in the sitting position survived until hospital discharge, while 33 (6.1%) patients out of those found in the lying positions survived. The univariable analysis showed that the sitting position was associated with female sex, older age, previously implanted implantable cardioverter-defibrillator (ICD) before OHCA. The multivariable logistic revealed that the sitting position was independently associated with chest pain and the presence of ICD.

Patients found in a sitting position at the arrival of EMS constituted 6.5% of patients with OHCA in whom resuscitation attempts were undertaken and were at higher risk of unfavorable outcomes.

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  1. Cummins RO, Chamberlain DA, Abramson NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation. 1991; 84(2): 960–975.
  2. Berdowski J, Berg RA, Tijssen JGP, et al. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010; 81(11): 1479–1487.
  3. Gräsner JT, Herlitz J, Koster RW, et al. Quality management in resuscitation--towards a European cardiac arrest registry (EuReCa). Resuscitation. 2011; 82(8): 989–994.
  4. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2015; 131(4): e29–322.
  5. Gach D, Nowak JU, Krzych ŁJ. Epidemiology of out-of-hospital cardiac arrest in the Bielsko-Biala district: a 12-month analysis. Kardiol Pol. 2016; 74(10): 1180–1187.
  6. Nadolny K, Zyśko D, Obremska M, et al. Analysis of out-of-hospital cardiac arrest in Poland in a 1-year period: data from the POL-OHCA registry. Kardiol Pol. 2020; 78(5): 404–411.
  7. D'Souza DH, Harish S, Rajesh M, et al. Rigor mortis in an unusual position: Forensic considerations. Int J Appl Basic Med Res. 2011; 1(2): 120–122.
  8. Panhuyzen-Goedkoop NM, Wellens HJ, Piek JJ. Early recognition of sudden cardiac arrest in athletes during sports activity. Neth Heart J. 2018; 26(1): 21–25.
  9. Bhatnagar V, Jinjil K, Dwivedi D, et al. Cardiopulmonary Resuscitation: Unusual Techniques for Unusual Situations. J Emerg Trauma Shock. 2018; 11(1): 31–37.
  10. Linderoth G, Møller TP, Folke F, et al. Medical dispatchers' perception of visual information in real out-of-hospital cardiac arrest: a qualitative interview study. Scand J Trauma Resusc Emerg Med. 2019; 27(1): 8.
  11. Freire-Tellado M, Pavón-Prieto MD, Fernández-López M, et al. Does the recovery position threaten cardiac arrest victim's safety assessment? Resuscitation. 2016; 105: e1.
  12. Kiyohara K, Nishiyama C, Kiguchi T, et al. Out-of-hospital cardiac arrests in the toilet in Japan: a population-based descriptive study. Acute Med Surg. 2018; 5(4): 369–373.
  13. Zyśko D, Fedorowski A, Nilsson D, et al. Tilt testing results are influenced by tilt protocol. Europace. 2016; 18(7): 1108–1112.
  14. Liu X, Asirvatham S, Kabell GG. Orthostatic increase in defibrillation threshold leading to defibrillation failure and prolonged cardiac arrest in a sitting position: Lessons from a patient's near-fatal experience. HeartRhythm Case Rep. 2016; 2(4): 313–317.
  15. Nadolny K, Bujak K, Kucap M, et al. The Silesian Registry of Out-of-Hospital Cardiac Arrest: Study design and results of a three-month pilot study. Cardiol J. 2020; 27(5): 566–574.
  16. Linderoth G, Hallas P, Lippert FK, et al. Challenges in out-of-hospital cardiac arrest - A study combining closed-circuit television (CCTV) and medical emergency calls. Resuscitation. 2015; 96: 317–322.
  17. Hayashi S, Toyoshima H, Tanabe N, et al. Activity immediately before the onset of non-fatal myocardial infarction and sudden cardiac death. Jpn Circ J. 1996; 60(12): 947–953.
  18. Abe H, Kohno R, Oginosawa Y. Characteristics of syncope in Japan and the Pacific rim. Prog Cardiovasc Dis. 2013; 55(4): 364–369.
  19. Zyśko D, Fedorowski A, Sutton R. Cardiac arrest during recovery after tilt-induced vasodepressor syncope in a 76-year old man. Journal of Acute Medicine. 2016; 6(3): 67–69.
  20. https://www.researchgate.net/publication/332820518_Management_of_cardiac_arrest_during_neurosurgery_in_adults (13.10.2020).
  21. Ryu HHo, Moore JC, Yannopoulos D, et al. The Effect of Head Up Cardiopulmonary Resuscitation on Cerebral and Systemic Hemodynamics. Resuscitation. 2016; 102: 29–34.
  22. Park YJ, Hong KiJ, Shin SDo, et al. Worsened survival in the head-up tilt position cardiopulmonary resuscitation in a porcine cardiac arrest model. Clin Exp Emerg Med. 2019; 6(3): 250–256.
  23. Clawson J, Olola C, Heward A, et al. Ability of the medical priority dispatch system protocol to predict the acuity of "unknown problem" dispatch response levels. Prehosp Emerg Care. 2008; 12(3): 290–296.
  24. Koster RW, Baubin MA, Bossaert LL, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation. 2010; 81(10): 1277–1292.
  25. Jagosz A, Bursy D, Sobon A, et al. In-hospital sudden cardiac arrest protocol analysis. Kardiol Pol. 2018; 76(2): 376–380.