Impedance threshold device

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")

Impedance threshold device
SpecialtyCardiology

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.[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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