The ITD works by providing up to 7 cm H2O (approximately 5 mmHg) resistance to inspiratory air flow, effectively turning the thorax into a vacuum pump upon each inhalation which lowers the intrathoracic pressure (ITP) and facilitates venous return to . The ResQGARD impedance threshold device (ITD) provides a rapid, safe, and non-invasive way to improve perfusion in spontaneously breathing hypotensive patients. Patients were randomly assigned to undergo CPR that included either an active ITD or an identical-appearing sham ITD. The ePub format uses eBook readers, which have several "ease of reading" features These analyses were fraught with heterogeneity (respectively, p=0.055, p=0.236, and p=0.011) and inconsistency (respectively, I-squared=51% , I-squared=27% , and I-squared=67%). All rights reserved. Resuscitation 2008;77:387-394, 19. Companies like Stryker, Waters & Zoll Medical Corp have been associated with Impedance threshold device. Randomized trials were searched in MEDLINE/PubMed according to a strategy modified from Biondi-Zoccai et al [21], using as key-words: cardiac arrest, impedance threshold device, and random* trial* (with * denoting a wildcard). EMS personnel were trained in ITD function, proper use of the ITD, and all aspects of protocol implementation, with an emphasis on the optimal performance of CPR according to local guidelines.13 The trial included a run-in phase; EMS personnel were required to provide evidence of acceptable performance to an internal monitoring committee before they were permitted to participate in the main trial. Crit Care Med 2006;34:Suppl:S466-S473, 5. elsewhere in this issue of the Journal.10 Most patients were enrolled simultaneously in both components of the ROC Prehospital Resuscitation Impedance Valve and Early Versus Delayed Analysis (ROC PRIMED) trial: the active-ITD-versus-sham-ITD component and the early-analysis-versus-later-analysis component, although the eligibility criteria for the two components were slightly different. All 10 sites halted enrollment in November 2009, when the data and safety monitoring board recommended termination because interim analysis showed that the findings were not likely to change with continuation of the study. Use of an impedance threshold device improves short-term outcomes following out-of-hospital cardiac arrest. G Biondi-Zoccai, A Abbate, [], and G Frati. Retraining occurred at periodic intervals throughout the trial, and the committee monitored CPR performance and compliance with the protocol. Conversely, ITD alone was not beneficial for ROSC, favorable neurologic outlook, or survival (respectively OR=0.98 [0.89-1.07], p for effect=0.611, 1.01 [0.85-1.21], p for effect=0.903, and 1.01 [0.86-1.17], p for effect=0.950, using the fixed-effects model). Details of the trial design and the relationship between the two studies can be found in the article by Stiell et al.,10 in a previously published description of the trial methods,11 and in the Supplementary Appendix. The ResQPOD impedance threshold device (ITD) is a simple, non-invasive device that delivers intrathoracic pressure regulation (IPR) therapy during basic or advanced life support CPR to improve perfusion. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. 2022 Jan;1507(1):37-48. doi: 10.1111/nyas.14580. 2011 Sep 20;8(11):611. doi: 10.1038/nrcardio.2011.146. Computations were performed with Comprehensive Meta-Analysis software (Biostat, Englewood, NJ, USA). During inspiration, a negative pressure (created from expansion of the thorax) draws air into the lungs. To compare cardiopulmonary resuscitation (CPR) with a compression to ventilation (C:V) ratio of 15:2 vs. 30:2, with and without use of an impedance threshold device (ITD). Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest. The impedance threshold device (ITD) is designed to enhance venous return and cardiac output during cardiopulmonary resuscitation (CPR) by increasing the degree of negative intrathoracic. The Global Unique Device Identification Database (GUDID) contains key device identification information submitted to the FDA about medical devices that have Unique Device Identifiers (UDI). Aufderheide TP, Frascone RJ, Wayne MA, et al. The ResQGARD is an impedance threshold device (ITD) that provides therapeutic resistance to inspiration in spontaneously breathing patients. 3 in the Supplementary Appendix). When using an impedance threshold device during cardiac arrest, it is important to: Deliver each ventilation over a period of 1 second. Application of impedance threshold devices during cardiopulmonary cerebral resuscitation. Circulation 2005;112:Suppl:IV47-IV50, 10. The https:// ensures that you are connecting to the The ResQPOD Impedance Threshold Device (ITD) is a simple, non-invasive device that helps EMS and hospitals improve perfusion during basic or advanced life support. An official website of the United States government. It is difficult to define which is the most appropriate attitude towards such clinical conundrum. ); the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa (I.G.S., C.M.C. This investigation will evaluate an impedance threshold device (ITD) as a VIIP countermeasure. J Trauma. There were also no significant differences in the secondary outcomes, including rates of return of spontaneous circulation on arrival at the emergency department, survival to hospital admission, and survival to hospital discharge. N Engl J Med. The first EMS system entered the run-in phase in June 2007. The impedance threshold device (ITD) is designed to enhance venous return and cardiac output during cardiopulmonary resuscitation (CPR) by increasing the degree of negative intrathoracic pressure. Forest plot for survival at longest available follow-up, reporting individual and summary effect estimates based on fixed effects. Aufderheide TP, Sigurdsson G, Pirrallo RG, et al. 2011 Sep 1;365(9):850-1. doi: 10.1056/NEJMe1108108. A total of 260 patients (6.0% . Physiological studies in animals and humans have suggested that interventions capable of decreasing mean intrathoracic pressure can augment the return of venous blood to the heart and improve hemodynamics during CPR.3-5,7 Despite such findings, this large effectiveness trial did not confirm a survival advantage with the use of an active ITD during standard CPR in patients with nontraumatic, out-of-hospital cardiac arrest. Improved Survival With Extracorporeal Cardiopulmonary Resuscitation Despite Progressive Metabolic Derangement Associated With Prolonged Resuscitation. N Engl J Med. ); the Department of Medicine, Johns Hopkins Medical Institutions, Baltimore (M.L.W. Most recently, two large studies have focused on the use of ITD in the management of patients with OOHCA undergoing CPR, with disappointingly conflicting results [11,12]. 2 in the Supplementary Appendix). Forest plot for return of spontaneous circulation (ROSC), reporting individual and summary effect estimates based on fixed effects. Reducing ventilation frequency combined with an inspiratory impedance device improves CPR efficiency in swine model of cardiac arrest. Vital organ blood flow with the impedance threshold device. 2Yannopoulos D, et al. From laboratory science to six emergency medical services systems: new understanding of the physiology of cardiopulmonary resuscitation increases survival rates after cardiac arrest. ); and the Department of Emergency Medicine, Virginia Commonwealth University, Richmond, (J.P.O.). Resuscitation 2008;78:179-185, 12. Epub 2013 May 10. both in Vancouver, Canada; the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland (M.R.D., T.A.S. Insights & Analytics Supported by a series of cooperative agreements with 10 regional clinical centers and one data coordinating center (5U01 HL077863, HL077881, HL077871, HL077872, HL077866, HL077908, HL077867, HL077887, HL077873, HL077865) from the National Heart, Lung, and Blood Institute in partnership with the National Institute of Neurological Disorders and Stroke, U.S. Army Medical Research and Materiel Command, the Institute of Circulatory and Respiratory Health of the Canadian Institutes of Health Research, Defence Research and Development Canada, the Heart and Stroke Foundation of Canada, and the American Heart Association. Several databases were searched for studies testing the effectiveness of impedance threshold devices in patients with cardiac arrest. The authors' affiliations are listed in the Appendix. One approach would be to disregard altogether ITD as ineffective (at least as long as the overall analysis is concerned). 5Convertino VA, et al. There were no significant differences in a priori subgroup analyses between the sham-ITD and active-ITD groups (Fig. Impedance threshold device is selectively known in the Medical Procedure field. Eisenberg MS, Psaty BM. The authors' affiliations are as follows: the Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee (T.P.A., R.G.P. Lai SM, Duncan PW. J Emerg Med 2011;41 (5):549-558. Previous studies have suggested that the use of an ITD during CPR may improve survival rates after cardiac arrest. Accurate Compression and Ventilation Times. The ResQGARD ITD provides a rapid, safe, and noninvasive way to improve perfusion in spontaneously breathing hypotensive patients. One ITD, the ResQGARD ITD 7, is a single-use valve that can be attached to a facemask or small mouthpiece to treat. Andreka P, Frenneaux MP. A trial of an impedance threshold device in out-of-hospital cardiac arrest. Despite remarkable improvements in the primary prevention of the most common causes of OOHCA, this condition remains common and ominous [27]. The ITD is a rather simple and relatively inexpensive device consisting of a valve interconnected between the patient airways and the ventilation means used during CPR. We compared the use of an active ITD with that of a sham ITD in patients with out-of-hospital cardiac arrest who underwent standard CPR at 10 sites in the United States and Canada. Network Meta-Analysis: Evidence Synthesis with Mixed Treatment Comparison. However, exploratory analysis focusing on the combined use of impedance threshold devices with active compression-decompression suggests that this combo treatment may be useful to improve patient prognosis. Use of the ITD was terminated on arrival at the hospital. Mean scores on the modified Rankin scale were compared between study groups with the use of a two-sample t-test with unequal variances. Information and tools for librarians about site license offerings. Although use of the modified Rankin scale has been validated for assessing the effects of stroke, it lacks validation for cardiac arrest. We are experimenting with display styles that make it easier to read articles in PMC. Aufderheide TP, Lurie KG. Aufderheide TP, Frascone RJ, Wayne MA, Mahoney BD, Swor RA, Domeier RM, Olinger ML, Holcomb RG, Tupper DE, Yannopoulos D, Lurie KG. Epub 2021 Feb 20. You may switch to Article in classic view. This is at odds with real-world observational data, which suggest that ITD has a significant beneficial impact on patient prognosis [13,14]. The ResQPOD ITD lowers intrathoracic pressure during the recoil phase of CPR by selectively restricting unnecessary airflow into the chest. Exploratory analysis showed that combined use of impedance threshold devices with active compression-decompression significantly increased the likelihood of return of spontaneous circulation (odds ratio=1.19 [1.00-1.40], p=0.045), favorable neurologic outcome (odds ratio=1.60 [1.14-2.25], p=0.006), and long-term survival (odds ratio=1.52 [1.11-2.08], p=0.009). Devices used to provide ACE-CPR: (1) an automated APPD to elevate the head and thorax, (2) a manual active compression-decompression CPR device and/or an automated CPR device attached to the. Address reprint requests to Dr. Aufderheide at the Department of Emergency Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Pavilion 1P, Milwaukee, WI 53226, or at [emailprotected]. device 1. a machine or tool used for a specific task; contrivance 2. any ornamental pattern or picture, as in embroidery 3. computer hardware that is designed for a specific function 4. a particular pattern of words, figures of speech, etc., used in literature to produce an effect on the reader Collins Discovery Encyclopedia, 1st edition . U01 HL077866/HL/NHLBI NIH HHS/United States, U01 HL077872-08/HL/NHLBI NIH HHS/United States, U01 HL077863-08/HL/NHLBI NIH HHS/United States, U01 HL077881/HL/NHLBI NIH HHS/United States, U01 HL077867/HL/NHLBI NIH HHS/United States, U01 HL077867-08/HL/NHLBI NIH HHS/United States, U01 HL077887-08/HL/NHLBI NIH HHS/United States, U01 HL077871/HL/NHLBI NIH HHS/United States, U01 HL077887/HL/NHLBI NIH HHS/United States, U01 HL077885/HL/NHLBI NIH HHS/United States, U01 HL077865/HL/NHLBI NIH HHS/United States, U01 HL077873-08/HL/NHLBI NIH HHS/United States, U01 HL077863/HL/NHLBI NIH HHS/United States, U01 HL077908/HL/NHLBI NIH HHS/United States, U01 HL077908-06/HL/NHLBI NIH HHS/United States, U01 HL077873/HL/NHLBI NIH HHS/United States, 5U01 HL077863/HL/NHLBI NIH HHS/United States, U01 HL077871-08/HL/NHLBI NIH HHS/United States, U01 HL077866-08/HL/NHLBI NIH HHS/United States, U01 HL077872/HL/NHLBI NIH HHS/United States. ), University of British Columbia, and the British Columbia Emergency and Health Services Commission (J.C., D.A.) This effect is achieved by preventing the passive inflow of air into the chest during chest recoil between chest compressions without impeding active ventilation. The evidence base on ITD in patients with OOHCA undergoing CPR is apparently inconclusive, with a neutral impact of clinically relevant outcomes. This interaction between treatment effect (expressed as the logarithm of the OR) and use of ACD-CPR together with ITD was confirmed at meta-regression analysis (b=0.195, p=0.045 in favor of ITD + ACD-CPR vs ITD alone for ROSC; b=0.500, p=0.018 for favorable neurologic outcome; and b=0.413, p=0.021 for overall survival).
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