Application of the Inspiratory Impedance Threshold Device and Its Research Progress_Journal of Biomedical Engineering

Authors：

WANGChunfei ^1,2 , ZHANGGuang ¹ , WUWenqin ³ ,  WUTaihu ¹

1. Institute of Medical Equipment, Academy of Military Medical Science, Tianjin 300161, China;
2. Department of Equipment, No. 174 PLA Hospital, Xiamen 361003, China;
3. Department of Science and Technology, Academy of Military Medical Science, Beijing 100850, China;

Corresponding author：

WUTaihu, Email: wutaihu@vip.sina.com

Keywords：

inspiratory impedance threshold device; cardiopulmonary resuscitation; chest compression; active compression-decompression cardiopulmonary resuscitation

DOI：

10.7507/1001-5515.20140083

Video：

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The inspiratory impedance threshold device (ITD) was put forward by Lurie in 1995, and was assigned as a class Ⅱa recommendation by the International Liaison Committee on Resuscitation (ILCOR) resuscitation guidelines in 2005. The ITD is used to augment negative intrathoracic pressure during recoil of the chest so as to enhance venous return and cardiac output, and to decrease intracranial pressure. In the recent years many researches on the ITD have been1 carried out, but all the researches can not take out a clear evidence to support or refute the use of the ITD. This paper introduces the structure and working principle of the ITD in detail, the research results and the debates about the use of the ITD for the past years.

Citation： WANGChunfei, ZHANGGuang, WUWenqin, WUTaihu. Application of the Inspiratory Impedance Threshold Device and Its Research Progress. Journal of Biomedical Engineering, 2014, 31(2): 452-457. doi: 10.7507/1001-5515.20140083 Copy

1.	SMITH S W,PARQUETTE B,LINDSTROM D,et al.An impedance threshold device increases blood pressure in hypotensive patients[J].J Emerg Med,2011,41(5):549-558.
2.	CONVERTINO V A,RYAN K L,RICKARDS C A,et al.Optimizing the respiratory pump:harnessing inspiratory resistance to treat systemic hypotension[J].Respir Care,2011,56(6):846-857.
3.	METZGER A,MATSUURA T,MCKNITE S,et al.Intrathoracic pressure regulation improves 24-hour survival in a pediatric porcine model of hemorrhagic shock[J].Pediatr Res,2011,70(3):267-271.
4.	KWON Y,METZGER A,MATSUURA T,et al.Prolonged treatment with the intrathoracic pressure regulator improves cerebral perfusion pressure and decreases intracranial pressure without compromising lung function in a porcine model of traumatic brain injury[J].Neurocrit Care,2010,13(Suppl):S183.
5.	LURIE K G,COFFEEN P,SHULTZ J,et al.Improving active compression-decompression cardiopulmonary resuscitation with an inspiratory impedance valve[J].Circulation,1995,91(6):1629-1632.
6.	HUFFMYER J L,GROVES D S,SCALZO D C,et al.The effect of the intrathoracic pressure regulator on hemodynamics and cardiac output[J].Shock,2011,35(2):114-116.
7.	LURIE K G.Positive pressure systems and methods for increasing blood pressure and circulation,US7766011 B2[P/OL].(2010-08-03)[2013-03-21].http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=7766011.PN.&OS=PN/7766011&RS=PN/7766011.
8.	AUFDERHEIDE T P,PIRRALLO R G,PROVO T A,et al.Clinical evaluation of an inspiratory impedance threshold device during standard cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest[J].Crit Care Med,2005,33(4):734-740.
9.	PIRRALLO R G,AUFDERHEIDE T P,PROVO T A,et al.Effect of an inspiratory impedance threshold device on hemodynamics during conventional manual cardiopulmonary resuscitation[J].Resuscitation,2005,66(1):13-20.
10.	VIGANI A,SHIH A C,BUCKLEY G J,et al.Cardiopulmonary effects of a new inspiratory impedance threshold device in acute hemorrhagic shock in dogs[J].J Vet Emerg Crit Care (San Antonio),2011,21(6):618-624.
11.	SHIH A C,VIGANI A,LORING N,et al.Cardiopulmonary effects of a new inspiratory impedance threshold device in anesthetized hypotensive dogs[J].Vet Anaesth Analg,2010,37(3):215-221.
12.	THIGPEN K,DAVIS S P,BASOL R,et al.Implementing the 2005 American Heart Association guidelines,including use of the impedance threshold device,improves hospital discharge rate after in-hospital cardiac arrest[J].Respir Care,2010,55(8):1014-1019.
13.	PANTAZOPOULOS I N,XANTHOS T T,VLACHOS I,et al.Use of the impedance threshold device improves survival rate and neurological outcome in a swine model of asphyxial cardiac arrest[J].Crit Care Med,2012,40(3):861-868.
14.	RAEDLER C,VOELCKEL W G,WENZEL V,et al.Vasopressor response in a porcine model of hypothermic cardiac arrest is improved with active compression-decompression cardiopulmonary resuscitation using the inspiratory impedance threshold valve[J].Anesth Analg,2002,95(6):1496-1502.
15.	PLAISANCE P,LURIE K G,PAYEN D.Inspiratory impedance during active compression-decompression cardiopulmonary resuscitation:a randomized evaluation in patients in cardiac arrest[J].Circulation,2000,101(9):989-994.
16.	WOLCKE B B,MAUER D K,SCHOEFMANN M F,et al.Comparison of standard cardiopulmonary resuscitation versus the combination of active compression-decompression cardiopulmonary resuscitation and an inspiratory impedance threshold device for out-of-hospital cardiac arrest[J].Circulation,2003,108(18):2201-2205.
17.	PLAISANCE P,LURIE K G,VICAUT E,et al.Evaluation of an impedance threshold device in patients receiving active compression-decompression cardiopulmonary resuscitation for out of hospital cardiac arrest[J].Resuscitation,2004,61(3):265-271.
18.	PLAISANCE P,SOLEIL C,LURIE K G,et al.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[J].Crit Care Med,2005,33(5):990-994.
19.	METZGER A K,HERMAN M,MCKNITE S,et al.Improved cerebral perfusion pressures and 24-hr neurological survival in a porcine model of cardiac arrest with active compression-decompression cardiopulmonary resuscitation and augmentation of negative intrathoracic pressure[J].Crit Care Med,2012,40(6):1851-1856.
20.	SCHULTZ J,YANNOPOULOS D.A new standard dual-device method for CPR:the evolution of a new model of physiological synergy to improve patient care[J].Future Cardiol,2011,7(4):451-454.
21.	AUFDERHEIDE T P,FRASCONE R J,WAYNE M A,et al.Comparative effectiveness of standard CPR versus active compression decompression CPR with augmentation of negative intrathoracic pressure for treatment of out-of-hospital cardiac arrest:results from a randomized prospective study[J].Lancet,2011,377(9762):301-311.
22.	LURIE K G,MULLIGAN K A,MCKNITE S,et al.Optimizing standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve[J].Chest,1998,113(4):1084-1090.
23.	LURIE K G,VOELCKEL W G,ZIELINSKI T,et al.Improving standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve in a porcine model of cardiac arrest[J].Anesth Analg,2001,93(3):649-655.
24.	THAYNE R C,THOMAS D C,NEVILLE J D,et al.Use of an impedance threshold device improves short-term outcomes following out-of-hospital cardiac arrest[J].Resuscitation,2005,67(1):103-108.
25.	HINCHEY P R,MYERS J B,LEWIS R,et al.Improved out-of-hospital cardiac arrest survival after the sequential implementation of 2005 AHA guidelines for compressions,ventilations,and induced hypothermia:the Wake County experience[J].Ann Emerg Med,2010,56(4):348-357.
26.	HERFF H,RAEDLER C,ZANDER R,et al.Use of an inspiratory impedance threshold valve during chest compressions without assisted ventilation may result in hypoxaemia[J].Resuscitation,2007,72(3):466-476.
27.	MADER T J,KELLOGG A R,SMITH J,et al.A blinded,randomized controlled evaluation of an impedance threshold device during cardiopulmonary resuscitation in swine[J].Resuscitation,2008,77(3):387-394.
28.	BABBS C F.Design of near-optimal waveforms for chest and abdominal compression and decompression in CPR using computer-simulated evolution[J].Resuscitation,2006,68(2):277-293.
29.	AUFDERHEIDE T P,NICHOL G,REA T D,et al.A trial of an impedancethreshold device in out-of-hospital cardiac arrest[J].N Engl J Med,2011,365(9):798-806.
30.	American Heart Association.2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care part 6:CPR techniques and devices[J].Circulation.2005,112(24 suppl):IV47-IV50.
31.	SHUSTER M,LIM S H,DEAKIN C D,et al.2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations part7:CPR techniques and devices[C].Circulation,2010,122(16 Suppl 2):S338-S344.

1. SMITH S W,PARQUETTE B,LINDSTROM D,et al.An impedance threshold device increases blood pressure in hypotensive patients[J].J Emerg Med,2011,41(5):549-558.
2. CONVERTINO V A,RYAN K L,RICKARDS C A,et al.Optimizing the respiratory pump:harnessing inspiratory resistance to treat systemic hypotension[J].Respir Care,2011,56(6):846-857.
3. METZGER A,MATSUURA T,MCKNITE S,et al.Intrathoracic pressure regulation improves 24-hour survival in a pediatric porcine model of hemorrhagic shock[J].Pediatr Res,2011,70(3):267-271.
4. KWON Y,METZGER A,MATSUURA T,et al.Prolonged treatment with the intrathoracic pressure regulator improves cerebral perfusion pressure and decreases intracranial pressure without compromising lung function in a porcine model of traumatic brain injury[J].Neurocrit Care,2010,13(Suppl):S183.
5. LURIE K G,COFFEEN P,SHULTZ J,et al.Improving active compression-decompression cardiopulmonary resuscitation with an inspiratory impedance valve[J].Circulation,1995,91(6):1629-1632.
6. HUFFMYER J L,GROVES D S,SCALZO D C,et al.The effect of the intrathoracic pressure regulator on hemodynamics and cardiac output[J].Shock,2011,35(2):114-116.
7. LURIE K G.Positive pressure systems and methods for increasing blood pressure and circulation,US7766011 B2[P/OL].(2010-08-03)[2013-03-21].http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=7766011.PN.&OS=PN/7766011&RS=PN/7766011.
8. AUFDERHEIDE T P,PIRRALLO R G,PROVO T A,et al.Clinical evaluation of an inspiratory impedance threshold device during standard cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest[J].Crit Care Med,2005,33(4):734-740.
9. PIRRALLO R G,AUFDERHEIDE T P,PROVO T A,et al.Effect of an inspiratory impedance threshold device on hemodynamics during conventional manual cardiopulmonary resuscitation[J].Resuscitation,2005,66(1):13-20.
10. VIGANI A,SHIH A C,BUCKLEY G J,et al.Cardiopulmonary effects of a new inspiratory impedance threshold device in acute hemorrhagic shock in dogs[J].J Vet Emerg Crit Care (San Antonio),2011,21(6):618-624.
11. SHIH A C,VIGANI A,LORING N,et al.Cardiopulmonary effects of a new inspiratory impedance threshold device in anesthetized hypotensive dogs[J].Vet Anaesth Analg,2010,37(3):215-221.
12. THIGPEN K,DAVIS S P,BASOL R,et al.Implementing the 2005 American Heart Association guidelines,including use of the impedance threshold device,improves hospital discharge rate after in-hospital cardiac arrest[J].Respir Care,2010,55(8):1014-1019.
13. PANTAZOPOULOS I N,XANTHOS T T,VLACHOS I,et al.Use of the impedance threshold device improves survival rate and neurological outcome in a swine model of asphyxial cardiac arrest[J].Crit Care Med,2012,40(3):861-868.
14. RAEDLER C,VOELCKEL W G,WENZEL V,et al.Vasopressor response in a porcine model of hypothermic cardiac arrest is improved with active compression-decompression cardiopulmonary resuscitation using the inspiratory impedance threshold valve[J].Anesth Analg,2002,95(6):1496-1502.
15. PLAISANCE P,LURIE K G,PAYEN D.Inspiratory impedance during active compression-decompression cardiopulmonary resuscitation:a randomized evaluation in patients in cardiac arrest[J].Circulation,2000,101(9):989-994.
16. WOLCKE B B,MAUER D K,SCHOEFMANN M F,et al.Comparison of standard cardiopulmonary resuscitation versus the combination of active compression-decompression cardiopulmonary resuscitation and an inspiratory impedance threshold device for out-of-hospital cardiac arrest[J].Circulation,2003,108(18):2201-2205.
17. PLAISANCE P,LURIE K G,VICAUT E,et al.Evaluation of an impedance threshold device in patients receiving active compression-decompression cardiopulmonary resuscitation for out of hospital cardiac arrest[J].Resuscitation,2004,61(3):265-271.
18. PLAISANCE P,SOLEIL C,LURIE K G,et al.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[J].Crit Care Med,2005,33(5):990-994.
19. METZGER A K,HERMAN M,MCKNITE S,et al.Improved cerebral perfusion pressures and 24-hr neurological survival in a porcine model of cardiac arrest with active compression-decompression cardiopulmonary resuscitation and augmentation of negative intrathoracic pressure[J].Crit Care Med,2012,40(6):1851-1856.
20. SCHULTZ J,YANNOPOULOS D.A new standard dual-device method for CPR:the evolution of a new model of physiological synergy to improve patient care[J].Future Cardiol,2011,7(4):451-454.
21. AUFDERHEIDE T P,FRASCONE R J,WAYNE M A,et al.Comparative effectiveness of standard CPR versus active compression decompression CPR with augmentation of negative intrathoracic pressure for treatment of out-of-hospital cardiac arrest:results from a randomized prospective study[J].Lancet,2011,377(9762):301-311.
22. LURIE K G,MULLIGAN K A,MCKNITE S,et al.Optimizing standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve[J].Chest,1998,113(4):1084-1090.
23. LURIE K G,VOELCKEL W G,ZIELINSKI T,et al.Improving standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve in a porcine model of cardiac arrest[J].Anesth Analg,2001,93(3):649-655.
24. THAYNE R C,THOMAS D C,NEVILLE J D,et al.Use of an impedance threshold device improves short-term outcomes following out-of-hospital cardiac arrest[J].Resuscitation,2005,67(1):103-108.
25. HINCHEY P R,MYERS J B,LEWIS R,et al.Improved out-of-hospital cardiac arrest survival after the sequential implementation of 2005 AHA guidelines for compressions,ventilations,and induced hypothermia:the Wake County experience[J].Ann Emerg Med,2010,56(4):348-357.
26. HERFF H,RAEDLER C,ZANDER R,et al.Use of an inspiratory impedance threshold valve during chest compressions without assisted ventilation may result in hypoxaemia[J].Resuscitation,2007,72(3):466-476.
27. MADER T J,KELLOGG A R,SMITH J,et al.A blinded,randomized controlled evaluation of an impedance threshold device during cardiopulmonary resuscitation in swine[J].Resuscitation,2008,77(3):387-394.
28. BABBS C F.Design of near-optimal waveforms for chest and abdominal compression and decompression in CPR using computer-simulated evolution[J].Resuscitation,2006,68(2):277-293.
29. AUFDERHEIDE T P,NICHOL G,REA T D,et al.A trial of an impedancethreshold device in out-of-hospital cardiac arrest[J].N Engl J Med,2011,365(9):798-806.
30. American Heart Association.2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care part 6:CPR techniques and devices[J].Circulation.2005,112(24 suppl):IV47-IV50.
31. SHUSTER M,LIM S H,DEAKIN C D,et al.2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations part7:CPR techniques and devices[C].Circulation,2010,122(16 Suppl 2):S338-S344.

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