title: Influence of an impedance threshold valve on ventilation with supraglottic airway devices during cardiopulmonary resuscitation in a manikin.
abstract: OBJECTIVE
  This study investigates if a n impedance threshold valve (ITV) might improve survival after cardiac arrest by increasing vital organ blood flow. The combination of ITV and supraglottic airway devices (SADs) has not been previously studied. This simulation study in a manikin aimed at analysing differences in ventilation with different SADs without and with an ITV.
  
  
  METHODS
  In a resuscitation manikin, cardiopulmonary resuscitation (CPR) was performed with interrupted (30:2) and continuous chest compressions using facemask, tracheal tube and 10 SADs (six different laryngeal masks, LT-D, LTS-D, Combitube((R)) and Easy Tube((R))). Ventilation was performed with and without an ITV. A total of 550 CPR cycles of 3-min duration were performed with chest compressions and ventilation standardised by use of a mechanical thumper device and an emergency ventilator.
  
  
  RESULTS
  Sufficient ventilation was possible with all devices tested. For ventilation during continuous chest compressions, there were significantly reduced tidal volumes for all airway devices with ITV use. By contrast, during interrupted chest compressions, no differences in tidal volumes with the ITV occurred in the majority of devices. The maximum reduction of tidal volume for any device was 7.8% of the volume reached without the ITV.
  
  
  CONCLUSIONS
  Based on the findings of this manikin trial, the use of an ITV for ventilation during CPR is possible in combination with supraglottic airway devices. Merging these two strategies warrants further clinical evaluation to judge the relevance of tidal volume reduction found in this trial.
authors.affiliation: Clinic of Anaesthesiology and Intensive Care Medicine, Neckar-Odenwald-Kliniken gGmbH, Hospitals Buchen and Mosbach, Buchen, Germany. harald.genzwuerker@neckar-odenwald-kliniken.de
authors.forename: H V
authors.initials: HV
authors.lastname: Genzwuerker
authors.forename: C
authors.initials: C
authors.lastname: Gernoth
authors.forename: J
authors.initials: J
authors.lastname: Hinkelbein
authors.forename: W
authors.initials: W
authors.lastname: Schmidbauer
authors.forename: T
authors.initials: T
authors.lastname: Kerner
mesh_terms: D000403:Airway Resistance / Q000502:physiology*; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation*; D004867:Equipment Design; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D017214:Laryngeal Masks; D008348:Manikins; D008955:Models, Cardiovascular; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000295:instrumentation*