Impact of impedance threshold devices on cardiopulmonary resuscitation: A systematic review and meta-analysis of randomized controlled studies

Luca Cabrini, Paolo Beccaria, Giovanni Landoni, Giuseppe G L Biondi-Zoccai, Imad Sheiban, Marta Cristofolini, Oliviero Fochi, Giulia Maj, Alberto Zangrillo

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)1625-1632
Number of pages8
JournalCritical Care Medicine
Issue number5
Publication statusPublished - May 2008


  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Impedance threshold devices
  • Meta-analysis
  • Randomized trials
  • Systematic review

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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