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Medical College of Wisconsin researchers show ResQ-Valve with CPR improves survival rate in cardiac arrest patients
Nov. 15, 2004 World issue - A Medical College of Wisconsin research team, led by emergency physicians Tom P. Aufderheide, MD, and Ronald G. Pirrallo, MD, has found that adding a simple device called the ResQ-Valve to standard CPR (cardio-pulmonary resuscitation) in cardiac arrest patients can double their survival rate long enough to be admitted to an Intensive Care Unit.
The results of their study were presented at the American Heart Association (AHA) Scientific Sessions on Nov. 8. The abstract has received the 2004 Best Critical Care Abstract Award from the AHA.
Since the outlook for people suffering cardiac arrest is poor, keeping them alive until they can enter an intensive care unit for treatment is vital to helping more of these patients to survive long-term, explained Dr. Aufderheide, Professor of Emergency Medicine and staff physician at the Froedtert & The Medical College of Wisconsin Emergency Medicine Department.
"Our findings demonstrate that the combination of standard CPR and the use of an impedance threshold device such as the ResQ-Valve significantly improved short-term survival rates for victims of cardiac arrest with pulseless electrical activity, a patient population previously shown to have a dismal outcome," Dr. Aufderheide said.
Cardiac arrest, when the heart simply stops beating or fibrillates, in effect quivers rather than beats, is one of the most critical medical emergencies. Unless blood flow is restored quickly, brain damage and/or death are the outcomes. The goal of standard CPR is to keep oxygen flowing to vital organs while trying to get the heart to resume pumping.
A device that selectively impedes gas exchange during the decompression phase of CPR to lower pressure in the lungs thereby enhancing venous blood return to the heart has been tested in animals. Those tests showed that such a device could increase circulation during CPR enough to increase the chance of normal circulation returning.
Based on these promising preliminary findings, Medical College researchers studied 230 patients; 114 were randomized to the ResQ-Valve and 116 were randomized to the sham valve.
The study was double blinded and neither the researchers nor patients knew which device they received. Both the ResQ-Valve and sham valves, wrapped in identical packaging, were given to emergency medical service teams in Milwaukee. As they went out on cardiac arrest calls, the patients were randomized by a computer to receive either the real or sham valve. The devices were initially attached to a facemask and then moved to the endotracheal tube once the patient was intubated.
The study was done in the Milwaukee County EMS system and patients were taken to all participating receiving hospitals in the Milwaukee area.
Additionally, a sub group of 22 patients received arterial catheterization at the scene of the cardiac arrest. A measure of their blood flow during CPR showed that the blood pressure of patients' with the active valve doubled, significantly improving hemodynamics during CPR, according to Dr. Pirrallo, Associate Professor of Emergency Medicine and a staff physician at the Froedtert & The Medical College of Wisconsin Emergency Medicine Department.
The results showed that many more patients survive to get further treatment in the hospital if the CPR used on them included the ResQ-Valve. The findings were dramatic:
In patients with no pulse (pulseless electrical activity or PEA), one-hour survival rates were 20 percent in the sham group vs. 56 percent in the ResQ-Valve group. ICU admission rates were 20 percent in the sham and 52 percent in the ResQ-Valve group; 24-hour survival was 12 percent in the sham and 30 percent in the ResQ-Valve.
Four patients in the ResQ-Valve group and two in the sham group were alive at the end of one year; both groups reported that their overall satisfaction and happiness about their lives was the same as before the cardiac arrest.
Complication rates were nearly zero and similar in both groups. No increased incidents of complications were seen with the ResQ-Valve.
"Our results support our hypothesis that the ResQ-Valve provides a means to increase circulation during CPR to a threshold level high enough to result in significantly improved short-term survival," Dr. Aufderheide said. "Based on the positive results from this study, a larger clinical trial with the improved ResQ-Valve is planned to evaluate long-term survival outcomes."
Medical College of Wisconsin researchers show ResQ-Valve with CPR improves survival rate in cardiac arrest patients
Nov. 15, 2004 World issue - A Medical College of Wisconsin research team, led by emergency physicians Tom P. Aufderheide, MD, and Ronald G. Pirrallo, MD, has found that adding a simple device called the ResQ-Valve to standard CPR (cardio-pulmonary resuscitation) in cardiac arrest patients can double their survival rate long enough to be admitted to an Intensive Care Unit.
The results of their study were presented at the American Heart Association (AHA) Scientific Sessions on Nov. 8. The abstract has received the 2004 Best Critical Care Abstract Award from the AHA.
Since the outlook for people suffering cardiac arrest is poor, keeping them alive until they can enter an intensive care unit for treatment is vital to helping more of these patients to survive long-term, explained Dr. Aufderheide, Professor of Emergency Medicine and staff physician at the Froedtert & The Medical College of Wisconsin Emergency Medicine Department.
"Our findings demonstrate that the combination of standard CPR and the use of an impedance threshold device such as the ResQ-Valve significantly improved short-term survival rates for victims of cardiac arrest with pulseless electrical activity, a patient population previously shown to have a dismal outcome," Dr. Aufderheide said.
Cardiac arrest, when the heart simply stops beating or fibrillates, in effect quivers rather than beats, is one of the most critical medical emergencies. Unless blood flow is restored quickly, brain damage and/or death are the outcomes. The goal of standard CPR is to keep oxygen flowing to vital organs while trying to get the heart to resume pumping.
A device that selectively impedes gas exchange during the decompression phase of CPR to lower pressure in the lungs thereby enhancing venous blood return to the heart has been tested in animals. Those tests showed that such a device could increase circulation during CPR enough to increase the chance of normal circulation returning.
Based on these promising preliminary findings, Medical College researchers studied 230 patients; 114 were randomized to the ResQ-Valve and 116 were randomized to the sham valve.
The study was double blinded and neither the researchers nor patients knew which device they received. Both the ResQ-Valve and sham valves, wrapped in identical packaging, were given to emergency medical service teams in Milwaukee. As they went out on cardiac arrest calls, the patients were randomized by a computer to receive either the real or sham valve. The devices were initially attached to a facemask and then moved to the endotracheal tube once the patient was intubated.
The study was done in the Milwaukee County EMS system and patients were taken to all participating receiving hospitals in the Milwaukee area.
Additionally, a sub group of 22 patients received arterial catheterization at the scene of the cardiac arrest. A measure of their blood flow during CPR showed that the blood pressure of patients' with the active valve doubled, significantly improving hemodynamics during CPR, according to Dr. Pirrallo, Associate Professor of Emergency Medicine and a staff physician at the Froedtert & The Medical College of Wisconsin Emergency Medicine Department.
The results showed that many more patients survive to get further treatment in the hospital if the CPR used on them included the ResQ-Valve. The findings were dramatic:
In patients with no pulse (pulseless electrical activity or PEA), one-hour survival rates were 20 percent in the sham group vs. 56 percent in the ResQ-Valve group. ICU admission rates were 20 percent in the sham and 52 percent in the ResQ-Valve group; 24-hour survival was 12 percent in the sham and 30 percent in the ResQ-Valve.
Four patients in the ResQ-Valve group and two in the sham group were alive at the end of one year; both groups reported that their overall satisfaction and happiness about their lives was the same as before the cardiac arrest.
Complication rates were nearly zero and similar in both groups. No increased incidents of complications were seen with the ResQ-Valve.
"Our results support our hypothesis that the ResQ-Valve provides a means to increase circulation during CPR to a threshold level high enough to result in significantly improved short-term survival," Dr. Aufderheide said. "Based on the positive results from this study, a larger clinical trial with the improved ResQ-Valve is planned to evaluate long-term survival outcomes."
