Comparison of Standard Cardiopulmonary Resuscitation Versus the Combination of Active Compression-Decompression Cardiopulmonary Resuscitation and an Inspiratory Impedance Threshold Device for Out-of-Hospital Cardiac Arrest

Abstract

Background-Active compression-decompression (ACD) CPR combined with an inspiratory impedance threshold device (ITD) improves vital organ blood flow during cardiac arrest. This study compared survival rates with ACDϩITD CPR versus standard manual CPR (S-CPR). Methods and Results-A prospective, controlled trial was performed in Mainz, Germany, in which a 2-tiered emergency response included early defibrillation. Patients with out-of-hospital arrest of presumed cardiac pathogenesis were sequentially randomized to ACDϩITD CPR or S-CPR by the advanced life support team after intubation. Rescuers learned which method of CPR to use at the start of each work shift. The primary end point was 1-hour survival after a witnessed arrest. With ACDϩITD CPR (nϭ103), return of spontaneous circulation and 1-and 24-hour survival rates were 55%, 51%, and 37% versus 37%, 32%, and 22% with S-CPR (nϭ107) (Pϭ0.016, 0.006, and 0.033, respectively). One-and 24-hour survival rates in witnessed arrests were 55% and 41% with ACDϩITD CPR versus 33% and 23% in control subjects (Pϭ0.011 and 0.019), respectively. One-and 24-hour survival rates in patients with a witnessed arrest in ventricular fibrillation were 68% and 58% after ACDϩITD CPR versus 27% and 23% after S-CPR (Pϭ0.002 and 0.009), respectively. Patients randomized Ն10 minutes after the call for help to the ACDϩITD CPR had a 3 times higher 1-hour survival rate than control subjects (Pϭ0.002). Hospital discharge rates were 18% after ACDϩITD CPR versus 13% in control subjects (Pϭ0.41). In witnessed arrests, overall neurological function trended higher with ACDϩITD CPR versus control subjects (Pϭ0.07). Conclusions-Compared with S-CPR, ACDϩITD CPR significantly improved short-term survival rates for patients with out-of-hospital cardiac arrest. Additional studies are needed to evaluate potential long-term benefits of ACDϩITD CPR.

Inspiratory resistance delays the reporting of symptoms with central hypovolemia: association with cerebral blood flow

“…The ITD is a small, light-weight, disposable plastic valve that was recently developed for treatment of a number of different clinical conditions associated with significant life-threatening hypotension (24,26,32,33,38). The ITD includes a specially designed valve that closes when the pressure within the thorax is less than atmospheric pressure and a second valve (termed the safety check valve) that opens at a preset negative intrathoracic pressure.…”

Ruptura gástrica por reanimação cardiopulmonar: relato de caso

“…Além disso, como já mencionado, manobras de ventilação excessiva -em especial através do uso de unidade-bolsa-valva-máscara, podem levar a distensão gástrica importante, predispondo a complicações como episódios de vômitos e aspiração, bem como de ruptura gástrica 6,14,15,19 . Com o intuito de otimizar a eficácia das manobras de RCP e incrementar a pressão de perfusão coronariana, inúmeros estudos vem comprovando a eficácia de dispositivos de compressão torácica capazes de gerar freqüência de massagem consistente inclusive durante o transporte do paciente, eliminando assim o componente de variabilidade na qualidade da massagem do socorrista 20,21 . Há evidências de incremento dos fluxos encefálico e cardíaco de até três vezes quando comparado com a RCP convencional 21,22 .…”

“…Com o intuito de otimizar a eficácia das manobras de RCP e incrementar a pressão de perfusão coronariana, inúmeros estudos vem comprovando a eficácia de dispositivos de compressão torácica capazes de gerar freqüência de massagem consistente inclusive durante o transporte do paciente, eliminando assim o componente de variabilidade na qualidade da massagem do socorrista 20,21 . Há evidências de incremento dos fluxos encefálico e cardíaco de até três vezes quando comparado com a RCP convencional 21,22 .…”

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

“…By preventing air influx, the ITD permits a greater negative pressure to build, allowing for greater cardiac and cerebral perfusion with ACD CPR alone. 6,[20][21][22] In 2011, the randomized ResQTrial study encompassing 46 emergency medical service agencies was published in The Lancet. This study examined the differences between standard CPR and ACD plus ITD CPR (using the ResQPump s ( Figure 1C) with the ResQPod s ( Figure 2); Zoll Medical Corp., Chelmsford, MA, USA) or patients with a suspected non-traumatic out-of-hospital cardiac arrest due to cardiac causes.…”

“…Some found no difference in survival to discharge between ACD CPR with or without the ITD. 21,22,41 One trial comparing conventional CPR and ACD plus ITD CPR found increased one-year survival following cardiac arrest with ACD plus ITD CPR use. 8,24 Due to a lack of research on this method, however, it is not a recommended alternative for conventional CPR unless performed by trained personnel.…”