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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 . 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 +/- sd 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 .
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Intervention_Physical
inspiratory impedance threshold device on a facemask and endotracheal tube
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inspiratory impedance threshold device ( ITD )
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endotracheal tube ( ETT )
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Intervention_Physical
active compression-decompression cardiopulmonary resuscitation
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Intervention_Physical
ITD
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facemask or ETT
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Intervention_Physical
active and sham ITD
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Intervention_Physical
facemask
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Intervention_Physical
ETT
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Intervention_Physical
active compression-decompression cardiopulmonary resuscitation
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Intervention_Physical
sham and an active ITD
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Intervention_Physical
facemask
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Intervention_Physical
ETT
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Intervention_Physical
sham
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active ITD
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Intervention_Physical
facemask and ETT
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Intervention_Physical
active ITD attached to a facemask or an ETT
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Intervention_Physical
ITD
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facemask
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ETT
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ITD-facemask combination
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Outcome_Physical
intrathoracic pressures
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Outcome_Physical
compression-decompression cardiopulmonary resuscitation
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Outcome_Physical
mean +/- sd maximum negative intrathoracic pressures
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Outcome_Physical
decompression phase of cardiopulmonary resuscitation
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Outcome_Physical
Decompression phase airway pressures
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Outcome_Physical
negative intratracheal pressure