EDECMO Podcast EDECMO 101 – Paul Pepe and Jon Marinaro – Head Up CPR
Jan 13, 2026
Paul Pepe, physician and resuscitation researcher known for work on CPR and emergency medicine. He explores head-up CPR physiology, the role of ACD+ITD priming, clinical data showing survival signals, links between head elevation and ECMO cannulation, and a provocative look at single-dose IV estrogen as a neuroprotective strategy.
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Supine CPR Has Major Physiologic Limits
- Conventional supine CPR generates about 15–20% of normal blood flow and is limited by opposing arterial and venous pressure waves in the head.
- Dr. Paul Pepe explains that reducing cranial venous pressure could let arterial flow perfuse the brain more effectively.
O'Hare AED Program Saved Nine Of Nine VF Arrests
- At Chicago O'Hare, installing AEDs yielded nine VF arrests in year one and nine survivors, many awake before EMS arrival.
- Paul Pepe uses this to illustrate how timely public defibrillation saves lives.
Stepwise Protocol For Head‑Up CPR
- Prime the pump with active compression–decompression (ACD) plus an impedance threshold device (ITD) for ~2 minutes before raising the head.
- Then slowly elevate head and thorax (about 20°) to improve cerebral perfusion while avoiding harm.