Improving active compression-decompression cardiopulmonary resuscitation with an inspiratory impedance valve

Lurie, K. G.; Coffeen, Paul; Shultz, Jeffrey J.; McKnite, Scott; Detloff, Barry L.S.; Mulligan, Katherine A.

doi:10.1016/0300-9572(96)83755-5

Cited by 23 publications

(52 citation statements)

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“…As such, using an ITV improved coronary perfusion pressure and myocardial blood flow in both standard (6) and ACD CPR in adult animal models (7). Furthermore, coronary perfusion pressure was significantly higher in patients receiving ACD CPR with the ITV when compared with ACD CPR alone (8).…”

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confidence: 95%

Effects of Active Compression-Decompression Cardiopulmonary Resuscitation with the Inspiratory Threshold Valve in a Young Porcine Model of Cardiac Arrest

et al. 2002

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Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) with the inspiratory threshold valve (ITV) has been recently recommended by the American Heart Association for treatment of adults in cardiac arrest (class IIb: alternative, useful intervention), but this new technique has never been used in a pediatric population. Thus, this study was designed to evaluate ACD ϩ ITV CPR in a young porcine model of cardiac arrest. After 10 min of ventricular fibrillation, and 8 min of standard CPR, ACD ϩ ITV CPR was performed in seven 4-to 6-wk-old pigs (8 -12 kg); defibrillation was attempted 8 min later. Within 2 min after initiation of ACD ϩ ITV CPR, mean (Ϯ SEM) coronary perfusion pressure increased from 18 Ϯ 2 to 24 Ϯ 3 mm Hg (p ϭ 0.018). During standard versus ACD ϩ ITV CPR, mean left ventricular myocardial and total cerebral blood flow was 59 Ϯ 21 versus 126 Ϯ 32 mL·min Ϫ1 ·100 g Ϫ1 , and 36 Ϯ 7 versus 60 Ϯ 15 mL· min Ϫ1 ·100 g Ϫ1 , respectively (p ϭ 0.028). Six of seven animals were successfully defibrillated, and survived Ͼ15 min. In conclusion, the combination of ACD ϩ ITV CPR significantly increased both coronary perfusion pressure and vital organ blood flow after prolonged standard CPR in this young porcine model of ventricular fibrillation. Pediatric cardiopulmonary arrest has a very poor prognosis, and survival rates range only from 2 to 17% (1, 2). Moreover, survivors often remain neurologically disabled (1). Inasmuch as current basic and ACLS methods often fail to restore cardiac function and preserve brain function, new alternative circulation methods merit evaluation in children. In this regard, the American Heart Association and European Resuscitation Council Guidelines emphasize the need for better data regarding epidemiology and treatment of pediatric cardiopulmonary arrest (3, 4).Intermittent impedance to the inflow of respiratory gases during the decompression phase of CPR has recently been shown to enhance CPR efficacy (5). As such, using an ITV improved coronary perfusion pressure and myocardial blood flow in both standard (6) and ACD CPR in adult animal models (7). Furthermore, coronary perfusion pressure was significantly higher in patients receiving ACD CPR with the ITV when compared with ACD CPR alone (8). However, neither ACD CPR alone nor ACD ϩ ITV CPR has been studied in a pediatric population yet, and a suitable ACD device for infants is not currently available. Moreover, in infants undergoing CPR, acquisition of rapid vascular access is not a simple task, even for an experienced emergency physician, and i.v. administration of vasopressor drugs may therefore be delayed, or even impossible. Whereas standard chest compressions alone are often ineffective to ensure adequate vital organ blood flow, ABSTRACT523

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confidence: 95%

Effects of Active Compression-Decompression Cardiopulmonary Resuscitation with the Inspiratory Threshold Valve in a Young Porcine Model of Cardiac Arrest

et al. 2002

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“…It is also a reasonable representation of open chest CPR with manual cardiac compression, which obviously works by a pure "cardiac pump" mechanism. A similar state of affairs can occur in children (and young pigs 46,47 ), who have small compliant chest walls.…”

Section: Modern Physiology Of Blood Flow During Cprmentioning

confidence: 79%

“…This approach is known as active compression-decompression CPR or ACD-CPR ( Figure 3). Today, active decompression of the chest during CPR can be accomplished using a specially designed plunger applied to the human sternum 46,[49][50][51] , which is sold commercially in Europe as the Ambu Cardiopump ® . Figure 4 illustrates the steady-state effect of active decompression of the chest to negative 20 mmHg, the maximum reported in the literature 50,52,53 .…”

Section: Modern Physiology Of Blood Flow During Cprmentioning

confidence: 99%

“…A major potential improvement in ACD-CPR is the use of an inspiratory impedance valve 46 for victims with an established endotracheal tube 51 . This valve fits on the end of the endotracheal tube and prevents "decompression of the decompression", that is, an inrush of air into the trachea during the active decompression phase.…”

Section: Practical Aspects Of Active Compression-decompression Cprmentioning

confidence: 99%

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Circulatory adjuncts: Newer methods of cardiopulmonary resuscitation

Babbs

2002

Cardiology Clinics

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“…18 These results led to the testing of an impedance threshold device (ITD) called the ResQPod s (Zoll Medical Corp., Chelmsford, MA, USA) along with the ResQPump s (Zoll Medical Corp., Chelmsford, MA, USA), to augment the benefits of ACD CPR. 19 The ResQPod s (Zoll Medical Corp., Chelmsford, MA, USA) can attach to a facemask or endotracheal tube (Figure 2). An ITD is used during basic and advanced life support as part of the airway, preventing inspiration during the CPR decompression phase.…”

Section: Addition Of the Impedance Threshold Devicementioning

confidence: 99%

The Development of Innovative Handheld Devices to Augment Cardiopulmonary Resuscitation Therapy and External Cardioversion and Defibrillation

Gershman

Needelman

Schwarzwald

et al. 2017

J Innov Cardiac Rhythm Manage

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Improving active compression-decompression cardiopulmonary resuscitation with an inspiratory impedance valve

Cited by 23 publications

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Effects of Active Compression-Decompression Cardiopulmonary Resuscitation with the Inspiratory Threshold Valve in a Young Porcine Model of Cardiac Arrest

Effects of Active Compression-Decompression Cardiopulmonary Resuscitation with the Inspiratory Threshold Valve in a Young Porcine Model of Cardiac Arrest

Circulatory adjuncts: Newer methods of cardiopulmonary resuscitation

The Development of Innovative Handheld Devices to Augment Cardiopulmonary Resuscitation Therapy and External Cardioversion and Defibrillation

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