Use of an inspiratory impedance threshold device on a facemask and endotracheal tube to reduce intrathoracic pressures during the decompression phase of active compression-decompression cardiopulmonary resuscitation

被引:48
作者
Plaisance, P [1 ]
Soleil, C
Lurie, KG
Vicaut, E
Ducros, L
Payen, D
机构
[1] Lariboisiere Univ Hosp, Dept Anesthesiol & Crit Care, Paris, France
[2] Lariboisiere Univ Hosp, Clin Res Unit, Paris, France
[3] Adv Circulatory Syst, Eden Prairie, MN USA
关键词
cardiac arrest; active compression-decompression; cardiopulmonary resuscitation; impedance threshold device; emergency medical services; ventilation;
D O I
10.1097/01.CCM.0000163235.18990.F6
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Introduction: Use of an inspiratory impedance threshold device (ITD) significantly increases coronary perfusion pressures and survival in patients ventilated with an endotracheal tube (ETT) during active compression- decompression cardiopulmonary resuscitation. We tested the hypothesis that the ITD could lower intratracheal pressures when attached to either a facemask or ETT. Methods. An active and sham ITD were randomly applied first to a facemask and then to an ETT during active compression decompression cardiopulmonary resuscitation in 13 out-of-hospital cardiac arrest patients in a randomized, double-blinded, prospective clinical trial. The compression -to- bag-valve ventilation ratio was 15:2. Airway pressures (surrogate for intrathoracic pressure) were measured with a pressure transducer. A sham and an active ITD were used for 1 min each in a randomized order, first on a facemask and then on an ETT. Statistical analyses were made using Friedman's and Wilcoxon's rank-sum tests. Results. For the primary end point, mean ± so maximum negative intrathoracic pressures (mm Hg) during the decompression phase of cardiopulmonary resuscitation were -1.0 ± 0.73 mm Hg with a sham vs. -4.6 ± 3.7 mm Hg with an active ITD on the facemask (p =.003) and -1.3 ± 1.3 mm Hg with a sham ITD vs. -7.3 ± 4.5 mm Hg with an active ITD on an ETT (p =.0009). Decompression phase airway pressures with the facemask and ETT were not statistically different. Conclusions. Use of an active ITD attached to a facemask or an ETT resulted in a significantly lower negative intratracheal pressure during the decompression phase of active compression-decompression cardiopulmonary resuscitation when compared with controls. Airway pressures with an ITD on either a facemask or ETT were similar. The ITD-facemask combination was practical and enables rapid deployment of this life-saving technology.
引用
收藏
页码:990 / 994
页数:5
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