title: Evaluation of an impedance threshold device in patients receiving active compression-decompression cardiopulmonary resuscitation for out of hospital cardiac arrest.
abstract: OBJECTIVE
  The purpose of this multicentre clinical randomized controlled blinded prospective trial was to determine whether an inspiratory impedance threshold device (ITD), when used in combination with active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), would improve survival rates in patients with out-of-hospital cardiac arrest.
  
  
  RESULTS
  Patients were randomized to receive either a sham (n = 200) or an active impedance threshold device (n = 200) during advanced cardiac life support performed with active compression-decompression cardiopulmonary resuscitation. The primary endpoint of this study was 24 h survival. The 24 h survival rates were 44/200 (22%) with the sham valve and 64/200 (32%) with the active valve (P = 0.02). The number of patients who had a return of spontaneous circulation (ROSC), intensive care unit (ICU) admission, and hospital discharge rates was 77 (39%), 57 (29%), and 8 (4%) in the sham valve group versus 96 (48%) (P = 0.05), 79 (40%) (P = 0.02), and 10 (5%) (P = 0.6) in the active valve group. Six out of ten survivors in the active valve group and 1/8 survivors in the sham group had normal neurological function at hospital discharge (P = 0.1).
  
  
  CONCLUSIONS
  The use of an impedance valve in patients receiving active compression-decompression cardiopulmonary resuscitation for out-of-hospital cardiac arrest significantly improved 24 h survival rates.
authors.affiliation: Department of Anesthesiology and Critical Care, Lariboisière University Hospital, 2 Rue Ambroise Paré, 75010 Paris, France. plaisance@claranet.fr
authors.forename: Patrick
authors.initials: P
authors.lastname: Plaisance
authors.forename: Keith G
authors.initials: KG
authors.lastname: Lurie
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Dominique
authors.initials: D
authors.lastname: Martin
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Gueugniaud
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Petit
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods; D004311:Double-Blind Method; D004554:Electric Countershock; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006336:Heart Massage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D015996:Survival Rate