Evaluation of an impedance threshold device in patients receiving active compression-decompression cardiopulmonary resuscitation for out of hospital cardiac arrest.
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.
Plaisance
Patrick
P
Department of Anesthesiology and Critical Care, Lariboisière University Hospital, 2 Rue Ambroise Paré, 75010 Paris, France. plaisance@claranet.fr
Lurie
Keith G
KG
Vicaut
Eric
E
Martin
Dominique
D
Gueugniaud
Pierre-Yves
PY
Petit
Jean-Luc
JL
Payen
Didier
D
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