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Impedance threshold device

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Impedance threshold device
SpecialtyCardiology

An inspiratory impedance threshold device is a valve used in cardiopulmonary resuscitation (CPR) to decrease intrathoracic pressure and improve venous return to the heart. The valve is a part of a mask or other breathing device such as an endotracheal tube, and may open at high or low pressures (called "cracking pressures.")[citation needed]

ITDs are still in the early phases of clinical use, but preliminary investigational studies have suggested a potential benefit in achieving return of spontaneous circulation (ROSC) and early improvement after cardiopulmonary arrest in humans.[1] More recently, the Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation Impedance Valve and Early Versus Delayed Analysis (PRIMED) study (n=8718) failed to demonstrate improved outcomes with the use of an impedance threshold device (ITD) as an adjunct to conventional CPR when compared with use of a sham device. Quality of cardiopulmonary resuscitation (CPR) was a deciding factor, with ITD increasing survival when in combination with "acceptable" CPR quality, but decreasing survival when CPR quality was not "acceptable".[2] This negative high-quality study prompted a Class III: No Benefit recommendation regarding routine use of the ITD.[3]

ITD use may only be beneficial if the cardiac arrest is witnessed and the response time is rapid.[4]

References

  1. ^ Cabrini L, Beccaria P, Landoni G, et al. (May 2008). "Impact of impedance threshold devices on cardiopulmonary resuscitation: a systematic review and meta-analysis of randomized controlled studies". Crit. Care Med. 36 (5): 1625–32. doi:10.1097/CCM.0b013e318170ba80. PMID 18434910.
  2. ^ Yannopoulos D, Aufderheide TP, Abella BS, Duval S, Frascone RJ, Goodloe JM, Mahoney BD, Nadkarni VM, Halperin HR, O'Connor R, Idris AH, Becker LB, Pepe PE (2015). "Quality of CPR: An important effect modifier in cardiac arrest clinical outcomes and intervention effectiveness trials". Resuscitation. 94: 106–113. doi:10.1016/j.resuscitation.2015.06.004. PMID 26073276.
  3. ^ "2015 Guidelines update". Part 6 Reommendations. American Heart Association. Retrieved 2019-01-02.
  4. ^ Wang CH, Tsai MS, Chang WT, Huang CH, Ma MH, Chen WJ, Fang CC, Chen SC, Lee CC (2015). "Active compression-decompression resuscitation and impedance threshold device for out-of-hospital cardiac arrest: a systematic review and metaanalysis of randomized controlled trials". Critical Care Medicine. 43 (4): 106–113. doi:10.1097/CCM.0000000000000820. PMID 25517475.

Further reading

  • Seekins MB, Reiss AJ (June 2011). "Application of impedance threshold devices during cardiopulmonary cerebral resuscitation". Journal of Veterinary Emergency and Critical Care. 21 (3): 187–92. doi:10.1111/j.1476-4431.2011.00640.x. PMID 21631704.
  • Pirracchio R, Payen D, Plaisance P (June 2007). "The impedance threshold valve for adult cardiopulmonary resuscitation: a review of the literature". Curr Opin Crit Care. 13 (3): 280–6. doi:10.1097/MCC.0b013e3281532b64. PMID 17468559.


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