Vital organ blood flow with the impedance threshold device

Aufderheide, Tom P.; Lurie, Keith G.

doi:10.1097/01.ccm.0000246013.47237.86

Cited by 20 publications

(15 citation statements)

References 46 publications

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“…Standard manual CPCR was developed to pump blood from the chest to the vital organs during chest compression and enhance venous return into the chest during relaxation of the chest wall. The goal is to maximize cerebral and myocardial perfusion 42–45 . The difference between mean arterial pressure and intracranial pressure is cerebral perfusion pressure.…”

Section: Basic Life Supportmentioning

confidence: 99%

Cardiopulmonary Resuscitation in Small Animal Medicine: An Update

Plunkett¹,

McMichael

2008

Veterinary Internal Medicne

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In December 2005, the American Heart Association published new guidelines for cardiopulmonary cerebral resuscitation (CPCR) in humans for the 1st time in 5 years. Many of the recommendations are based on research conducted in animal species and may be applicable to small animal veterinary patients. One important change that may impact how CPCR is performed in veterinary medicine is the recommendation to avoid administration of excessive ventilatory rates because this maneuver severely decreases myocardial and cerebral perfusion, decreasing the chance of survival. The new guidelines also emphasize the importance of providing well-executed, continuous, uninterrupted chest compressions. Interruption of chest compressions should be avoided and, if necessary, should be minimized to o10 seconds. During defibrillation, immediate resumption of chest compressions for 2 minutes after a single shock, before reassessment of the rhythm by ECG, is recommended. This recommendation replaces previous recommendations for the delivery of 3 defibrillatory shocks in rapid succession. Allowing permissive hypothermia postresuscitation has been found to be beneficial and may increase success rate. Medications utilized in cardiopulmonary resuscitation, including amiodarone, atropine, epinephrine, lidocaine, and vasopressin, along with the indications, effects, routes of administration, and dosages, are discussed. The application of the new guidelines to veterinary medicine as well as a review of cardiopulmonary resuscitation in small animals is provided.

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Section: Basic Life Supportmentioning

confidence: 99%

Cardiopulmonary Resuscitation in Small Animal Medicine: An Update

Plunkett¹,

McMichael

2008

Veterinary Internal Medicne

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“…The data in Figure 10 also support a similar mechanism for enhanced cerebral perfusion. Based on these observations in the heart and brain, we hypothesize that resistance during inspiration enhances circulation in a more global manner in vital organs 29,30 throughout the body, by increasing forward flow with elevated arterial pressure, and by active suction that pulls more blood through the capillary bed by a negative-pressure effect on reducing venous pressure. This "pull-through" mech- anism may be a new paradigm for hypotensive resuscitation and maintaining adequate tissue perfusion in the scenario of hemorrhage.…”

Section: Potential Mechanisms Of Action: Effects On Pressure Gradientmentioning

confidence: 99%

Optimizing the Respiratory Pump: Harnessing Inspiratory Resistance to Treat Systemic Hypotension

et al. 2011

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We review the physiology and affects of inspiration through a low level of added resistance for the treatment of hypotension. Recent animal and clinical studies demonstrated that one of the body's natural response mechanisms to hypotension is to harness the respiratory pump to increase circulation. That finding is consistent with observations, in the 1960s, about the effect of lowering intrathoracic pressure on key physiological and hemodynamic variables. We describe studies that focused on the fundamental relationship between the generation of negative intrathoracic pressure during inspiration through a low level of resistance created by an impedance threshold device and the physiologic sequelae of a respiratory pump. A decrease in intrathoracic pressure during inspiration through a fixed resistance resulting in a pressure difference of 7 cm H 2 O has multiple physiological benefits, including: enhanced venous return and cardiac stroke volume, lower intracranial pressure, resetting of the cardiac baroreflex, elevated cerebral blood flow oscillations, increased tissue blood flow/pressure gradient, and maintenance of the integrity of the baroreflexmediated coherence between arterial pressure and sympathetic nerve activity. While breathing has traditionally been thought primarily to provide gas exchange, studies of the mechanisms involved in animals and humans provide the physiological underpinnings for "the other side of breathing": to increase circulation to the heart and brain, especially in the setting of physiological stress. The existing results support the use of the intrathoracic pump to treat clinical conditions associated with hypotension, including orthostatic hypotension, hypotension during and after hemodialysis, hemorrhagic shock, heat stroke, septic shock, and cardiac arrest. Harnessing these fundamental mechanisms that control cardiopulmonary physiology provides new opportunities for respiratory therapists and others who have traditionally focused on ventilation to also help treat serious and often life-threatening circulatory disorders.

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“…(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) Compared with standard CPR, improved hemodymanics with use of the ITD is dependent on the quality of CPR provided (20)(21)(22)(23)(24)(25)(26) and the degree of chest wall recoil. (27,28) This concept has been evaluated in animals (6,7,(9)(10)(11)1416,18) as well as in human patients with prolonged cardiac arrest undergoing standard manual CPR.…”

Section: Background and Significancementioning

confidence: 99%

Resuscitation Outcomes Consortium (ROC) PRIMED cardiac arrest trial methods

Aufderheide¹,

Kudenchuk

Hedges

et al. 2008

Resuscitation

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Aim-The primary aim of this study is to compare survival to hospital discharge with a modified Rankin score (MRS) ≤3 between standard cardiopulmonary resuscitation (CPR) plus an active impedance threshold device (ITD) versus standard CPR plus a sham ITD in patients with out-ofhospital cardiac arrest. Secondary aims are to compare functional status and depression at discharge and at 3 and 6 months post discharge in survivors.Design: Prospective, double-blind, randomized, controlled, clinical trial. Population:Patients with non-traumatic out-of-hospital cardiac arrest treated by emergency medical services (EMS) providers. Setting: EMS systems participating in the Resuscitation Outcomes Consortium.Sample Size: Based on a one-sided significance level of 0.025, power = 0.90, a survival with MRS ≤ 3 to discharge rate of 5.33% with standard CPR and sham ITD, and two interim analyses, a maximum of 14,742 evaluable patients are needed to detect a 6.69% survival with MRS ≤ 3 to discharge with standard CPR and active ITD (1.36% absolute survival difference).Conclusion-If the ITD demonstrates the hypothesized improvement in survival, it is estimated that2,700 deaths from cardiac arrest per year would be averted in North America alone.

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Vital organ blood flow with the impedance threshold device

Cited by 20 publications

References 46 publications

Cardiopulmonary Resuscitation in Small Animal Medicine: An Update

Cardiopulmonary Resuscitation in Small Animal Medicine: An Update

Optimizing the Respiratory Pump: Harnessing Inspiratory Resistance to Treat Systemic Hypotension

Resuscitation Outcomes Consortium (ROC) PRIMED cardiac arrest trial methods

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