Impedance threshold device
{{Short description|Valve present in CPR breathing devices}}
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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"){{cn|date=February 2021}}
Overview
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.{{cite journal |vauthors=Cabrini L, Beccaria P, Landoni G, etal |title=Impact of impedance threshold devices on cardiopulmonary resuscitation: a systematic review and meta-analysis of randomized controlled studies |journal=Crit. Care Med. |volume=36 |issue=5 |pages=1625–32 |date=May 2008 |pmid=18434910 |doi=10.1097/CCM.0b013e318170ba80 }} 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".{{cite journal | vauthors=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 | title=Quality of CPR: An important effect modifier in cardiac arrest clinical outcomes and intervention effectiveness trials | journal= Resuscitation | volume=94 | pages=106–113 | year=2015 | doi= 10.1016/j.resuscitation.2015.06.004 | pmid = 26073276 }} This negative high-quality study prompted a Class III: No Benefit recommendation regarding routine use of the ITD.{{cite web | title = 2015 Guidelines update | work = Part 6 Reommendations | publisher = American Heart Association | url = https://eccguidelines.heart.org/index.php/tables/appendix-2015-guidelines-update-part-6-recommendations/ | access-date = 2019-01-02 }}
ITD use may only be beneficial if the cardiac arrest is witnessed and the response time is rapid.{{cite journal | vauthors=Wang CH, Tsai MS, Chang WT, Huang CH, Ma MH, Chen WJ, Fang CC, Chen SC, Lee CC | title=Active compression-decompression resuscitation and impedance threshold device for out-of-hospital cardiac arrest: a systematic review and metaanalysis of randomized controlled trials | journal= Critical Care Medicine | volume=43 | issue=4 | pages=106–113 | year=2015 | doi= 10.1097/CCM.0000000000000820 | pmid = 25517475}}
References
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Further reading
- {{cite journal |vauthors=Seekins MB, Reiss AJ |title=Application of impedance threshold devices during cardiopulmonary cerebral resuscitation |journal=Journal of Veterinary Emergency and Critical Care |volume=21 |issue=3 |pages=187–92 |date=June 2011 |pmid=21631704 |doi=10.1111/j.1476-4431.2011.00640.x}}
- {{cite journal |vauthors=Pirracchio R, Payen D, Plaisance P |title=The impedance threshold valve for adult cardiopulmonary resuscitation: a review of the literature |journal=Curr Opin Crit Care |volume=13 |issue=3 |pages=280–6 |date=June 2007 |pmid=17468559 |doi=10.1097/MCC.0b013e3281532b64}}
External links
- [https://cprcertify4u.com/ CPR Training & Resources]
Category:Cardiopulmonary resuscitation
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