Editorial
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World J Cardiol. Feb 26, 2010; 2(2): 19-26
Published online Feb 26, 2010. doi: 10.4330/wjc.v2.i2.19
Use of the impedance threshold device in cardiopulmonary resuscitation
Theano D Demestiha, Ioannis N Pantazopoulos, Theodoros T Xanthos
Theano D Demestiha, Department of Anatomy, University of Athens, Medical School, 11527, Athens, Greece
Ioannis N Pantazopoulos, Department of Experimental Surgery and Surgical Research, University of Athens, Medical School, 11527, Athens, Greece
Theodoros T Xanthos, Department of Experimental Surgery and Surgical Research, University of Athens, Medical School, 11527, Athens, Greece
Author contributions: Demestiha TD, Pantazopoulos IN and Xanthos TT analyzed and interpreted the literature; Pantazopoulos IN and Xanthos TT wrote the manuscript; Demestiha TD, Pantazopoulos IN and Xanthos TT revised the manuscript.
Correspondence to: Theodoros T Xanthos, PhD, Department of Experimental Surgery and Surgical Research, University of Athens, Medical School, 15B Agiou Thoma Street, 11527, Athens, Greece. theodorosxanthos@yahoo.com
Telephone: +30-210-7462500 Fax: +30-210-7462500
Received: February 9, 2010
Revised: February 23, 2010
Accepted: February 24, 2010
Published online: February 26, 2010
Abstract

Although approximately one million sudden cardiac deaths occur yearly in the US and Europe, cardiac arrest (CA) remains a clinical condition still characterized by a poor prognosis. In an effort to improve the cardiopulmonary resuscitation (CPR) technique, the 2005 American Heart Association (AHA) Guidelines for CPR gave the impedance threshold device (ITD) a Class IIa recommendation. The AHA recommendation means that there is strong evidence to demonstrate that ITD enhances circulation, improves hemodynamics and increases the likelihood of resuscitation in patients in CA. During standard CPR, venous blood return to the heart relies on the natural elastic recoil of the chest which creates a transient decrease in intrathoracic pressure. The ITD further decreases intrathoracic pressure by preventing respiratory gases from entering the lungs during the decompression phase of CPR. Thus, although ITD is placed into the respiratory circuit it works as a circulatory enhancer device that provides its therapeutic benefit with each chest decompression. The ease of use of this device, its ability to be incorporated into a mask and other airway devices, the absence of device-related adverse effects and few requirements in additional training, suggest that ITD may be a favorable new device for improving CPR efficiency. Since the literature is short of studies with clinically meaningful outcomes such as neurological outcome and long term survival, further evidence is still needed.

Keywords: Cardiopulmonary resuscitation, Coronary perfusion pressure, Impedance threshold device, Return of spontaneous circulation, Survival