Cardiac & Resuscitation, Exclusives, Heart of America, Patient Care, Top Story

Active Intrathoracic Pressure Regulation During Resuscitation

Active intrathoracic pressure regulation (aIPR) is a novel therapy approved for the treatment of low blood flow states, such as cardiac arrest. This therapy is delivered with a device called the CirQPOD that’s inserted into a standard respiratory circuit between the patient and a means to provide positive pressure ventilation (e.g., bag-valve balloon or mechanical ventilator). Between each positive pressure ventilation, aIPR decrease intrathoracic pressure to subatmospheric levels, which subsequently enhances blood return to the heart and increases stoke volume, cardiac output, arterial blood pressures and coronary perfusion pressures.

It also simultaneously decreases intracranial pressure and improves cerebral perfusion pressure and cerebral blood flow. The physiology has been confirmed in multiple animal studies and several human studies, during CPR and in the post-resuscitation phase. Intrathoracic pressure regulation relies on similar physiological principles of the impedance threshold device.1 Overall, aIPR therapy has significant potential to improve outcomes in patients in cardiac arrest, especially when used as part of an overall bundle of care.2–5

References

1. Lurie KG, Nemergut EC, Yannopoulos D, et al. The physiology of cardiopulmonary resuscitation. Anesth Analg. 2016;122(3):767–783.

2. Segal N, Parquette B, Ziehr J, et al. Intrathoracic pressure regulation during cardiopulmonary resuscitation: a feasibility case-series. Resuscitation 2013;84(4):450–453.

3. Kwon Y, Debaty G, Puertas L, et al. Effect of regulating airway pressure on intrathoracic pressure and vital organ perfusion pressure during cardiopulmonary resuscitation: A non-randomized interventional cross-over study. Scand J Trauma Resusc Emerg Med. 2015;23:83.

4. Debaty G, Metzger A, Rees J, et al. Enhanced perfusion during advanced life support improves survival with favorable neurologic function in a porcine model of refractory cardiac arrest. Crit Care Med. 2015;43(5):1087–1095.

5. Metzger A, Lick M, Berger P, et al. Active intrathoracic pressure regulation during post cardiac arrest care significantly reduces vasopressor requirements, improves cerebral blood flow and neurologically intact survival. Prehosp Emerg Care. 2017;21(1):94.