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TECHNOLOGY, COMPUTING, AND SIMULATION

Improving Standard Cardiopulmonary Resuscitation with an Inspiratory Impedance Threshold Valve in a Porcine Model of Cardiac Arrest

Keith G. Lurie, MD^*, Wolfgang G. Voelckel, MD^*, Todd Zielinski, MS^*, Scott McKnite, BS^*, Paul Lindstrom, BS^*, Colleen Peterson, RN^*, Volker Wenzel, MD, Karl H. Lindner, MD, Nemer Samniah, MD^*, and David Benditt, MD^*

*Department of Medicine, Cardiovascular Division, Cardiac Arrhythmia Center, University of Minnesota, Minneapolis, Minnesota; and Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria

Address correspondence and reprint requests to Keith G. Lurie, MD, Department of Medicine/Cardiovascular Division, University of Minnesota Medical School, MMC 508, AHC, 420 Delaware St. SE, Minneapolis, MN 55455. Address e-mail to lurie002{at}tc.umn.edu

To improve the efficiency of standard cardiopulmonary resuscitation (CPR), we evaluated the potential value of impeding respiratory gas exchange selectively during the decompression phase of standard CPR in a porcine model of ventricular fibrillation. After 6 min of untreated cardiac arrest, anesthetized farm pigs weighing 30 kg were randomized to be treated with either standard CPR with a sham valve (n = 11) or standard CPR plus a functional inspiratory impedance threshold valve (ITV^TM) (n = 11). Coronary perfusion pressure (CPP) (diastolic aortic minus right atrial pressure) was the primary endpoint. Vital organ blood flow was assessed with radiolabeled microspheres after 6 min of CPR, and defibrillation was attempted 11 min after starting CPR. After 2 min of CPR, mean ± SEM CPP was 14 ± 2 mm Hg with the sham valve versus 20 ± 2 mm Hg in the ITV group (P < 0.006). Significantly higher CPPs were maintained throughout the study when the ITV was used. After 6 min of CPR, mean ± SEM left ventricular and global cerebral blood flows were 0.10 ± 0.03 and 0.19 ± 0.03 mL · min^-1 · g^-1 in the Control group versus 0.19 ± 0.03 and 0.26 ± 0.03 mL · min^-1 · g^-1 in the ITV group, respectively (P < 0.05). Fifteen minutes after successful defibrillation, 2 of 11 animals were alive in the Control group versus 6 of 11 in the ITV group (not significant). In conclusion, use of an inspiratory impedance valve during standard CPR resulted in a marked increase in CPP and vital organ blood flow after 6 min of cardiac arrest.

IMPLICATIONS: This study describes a new inspiratory impedance valve that is attached to a facemask or breathing tube and used during cardiopulmonary resuscitation. The valve helps to draw more blood back into the heart after each chest compression. In a pig study of cardiac arrest, use of this new valve resulted in a doubling of the blood flow to the heart and a near normalization of blood flow to the brain. Clinical studies are underway to determine the potential benefit of this more efficient way to perform cardiopulmonary resuscitation in patients.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999