Impact of impedance threshold devices on cardiopulmonary resuscitation: A systematic review and meta-analysis of randomized controlled studies
Academic Article
Publication Date:
2008
abstract:
Objectives: Vital organ hypoperfusion significantly contributes
to the dismal survival rates observed with manual cardiopulmonary
resuscitation after cardiac arrest. The impedance threshold
device is a valve which reduces air entry into lungs during chest
recoil between chest compressions, producing a potentially beneficial
decrease in intrathoracic pressure and thus increasing
venous return to the heart. This review provides an update on the
impedance threshold device and underlines its effect on shortterm
survival.
Data Source: MedCentral, CENTRAL, PubMed, and conference
proceedings were searched (updated March 27, 2007). Authors
and external experts were contacted.
Study Selections: Three unblinded reviewers selected randomized
trials using an impedance threshold device in cardiopulmonary
resuscitation of nontraumatic out-of-hospital cardiac arrests.
Four reviewers independently abstracted patient, treatment
and outcome data.
Data Extraction: A total of 833 patients from five high quality
randomized studies were included in the analysis.
Data Synthesis: Pooled estimates showed that the impedance
threshold device consistently and significantly improved return to
spontaneous circulation (202/438 [46%] for impedance threshold
device group vs. 159/445 [36%] for control, relative risk [RR]
1.29 [1.10 –1.51], p .002), early survival (139/428 [32%] vs.
97/433 [22%], RR 1.45 [1.16 –1.80], p .0009) and favorable
neurologic outcome (39/307 [13%] vs. 18/293 [6%], RR 2.35
[1.30–4.24], p .004) with no effect on favorable neurologic
outcome in survivors (39/60 [65%] vs. 18/44 [41%]) nor an improved
survival at the longest available follow up (35/428 [8.2%]
vs. 24/433 [5.5%]).
Conclusions: This meta-analysis of randomized controlled studies
suggests that the impedance threshold device improves early
outcome in patients with out-of-hospital cardiac arrest undergoing
cardiopulmonary resuscitation.
to the dismal survival rates observed with manual cardiopulmonary
resuscitation after cardiac arrest. The impedance threshold
device is a valve which reduces air entry into lungs during chest
recoil between chest compressions, producing a potentially beneficial
decrease in intrathoracic pressure and thus increasing
venous return to the heart. This review provides an update on the
impedance threshold device and underlines its effect on shortterm
survival.
Data Source: MedCentral, CENTRAL, PubMed, and conference
proceedings were searched (updated March 27, 2007). Authors
and external experts were contacted.
Study Selections: Three unblinded reviewers selected randomized
trials using an impedance threshold device in cardiopulmonary
resuscitation of nontraumatic out-of-hospital cardiac arrests.
Four reviewers independently abstracted patient, treatment
and outcome data.
Data Extraction: A total of 833 patients from five high quality
randomized studies were included in the analysis.
Data Synthesis: Pooled estimates showed that the impedance
threshold device consistently and significantly improved return to
spontaneous circulation (202/438 [46%] for impedance threshold
device group vs. 159/445 [36%] for control, relative risk [RR]
1.29 [1.10 –1.51], p .002), early survival (139/428 [32%] vs.
97/433 [22%], RR 1.45 [1.16 –1.80], p .0009) and favorable
neurologic outcome (39/307 [13%] vs. 18/293 [6%], RR 2.35
[1.30–4.24], p .004) with no effect on favorable neurologic
outcome in survivors (39/60 [65%] vs. 18/44 [41%]) nor an improved
survival at the longest available follow up (35/428 [8.2%]
vs. 24/433 [5.5%]).
Conclusions: This meta-analysis of randomized controlled studies
suggests that the impedance threshold device improves early
outcome in patients with out-of-hospital cardiac arrest undergoing
cardiopulmonary resuscitation.
Iris type:
Articolo su Rivista
List of contributors:
Cabrini, L; Beccaria, P; Landoni, G; Biondi-Zoccai, Gg; Sheiban, I; Cristofolini, M; Fochi, O; Maj, G; Zangrillo, A
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