TY - JOUR
T1 - Impact of impedance threshold devices on cardiopulmonary resuscitation
T2 - A systematic review and meta-analysis of randomized controlled studies
AU - Cabrini, Luca
AU - Beccaria, Paolo
AU - Landoni, Giovanni
AU - Biondi-Zoccai, Giuseppe G L
AU - Sheiban, Imad
AU - Cristofolini, Marta
AU - Fochi, Oliviero
AU - Maj, Giulia
AU - Zangrillo, Alberto
PY - 2008/5
Y1 - 2008/5
N2 - 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 short-term 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.
AB - 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 short-term 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.
KW - Cardiac arrest
KW - Cardiopulmonary resuscitation
KW - Impedance threshold devices
KW - Meta-analysis
KW - Randomized trials
KW - Systematic review
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U2 - 10.1097/CCM.0b013e318170ba80
DO - 10.1097/CCM.0b013e318170ba80
M3 - Article
C2 - 18434910
AN - SCOPUS:42949178555
VL - 36
SP - 1625
EP - 1632
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 5
ER -