Despite the widespread practice of basic and advanced life support, over 1000 patients die each day in the United States from an out-of-hospital cardiac arrest. Even though they receive standard cardiopulmonary resuscitation (sCPR) the average national survival to hospital discharge for these patients is less than 5%. The applicants have developed the inspiratory impedance threshold device (ITD) to increase negative intrathoracic pressure during the decompression phase of sCPR, thereby doubling forward blood flow. The Phase 2 clinical trial demonstrated that intensive care unit admission rate (primary study endpoint) in patients with an initial heart rhythm of pulseless electrical activity increased from 19% to 52% (p=0.02). During Phase 2 investigators also discovered a fundamental new principle of blood flow during CPR: an inverse relationship between intrathoracic pressure and coronary perfusion pressure as well as cerebral perfusion pressure and survival rates. With increased intrathoracic pressure, coronary and cerebral perfusion pressures, as well as survival rates, decreased. The Phase 2 research further lead to the discovery that during sCPR ventilation rates and duration are often excessive and that the chest is often not allowed to fully recoil after each compression. Each of these common clinical errors was electronically recorded for the first time and then shown to be detrimental, if not deadly, in animal models of cardiac arrest. Based upon these Phase II results the applicants have improved the ITD by adding a ventilation timing light to guide proper ventilation and developed a new and improved hand position for sCPR to help promote full chest wall recoil. Another way to assure that the critically important full chest recoil occurs after each chest compression is by using active compression decompression (ACD) CPR, a technique also developed by the applicants that utilizes a hand held device. Based upon these Phase 2 results, the Phase 2 continuation research will be conducted to obtain sufficient clinical data for regulatory clearance for the ITD as a technology intended to improve 24-hour survival rates after cardiac arrest. A pivotal clinical trial is proposed in the form of a prospective, randomized, two-site clinical trial to: 1) determine the 24-hour survival rate when using the ITD with improved sCPR, and 2) to determine the 24-hour survival rate when using the ITD and assuring full chest wall recoil with ACD CPR. With 400,000 out-of-hospital deaths from cardiac arrest in the United States alone, widespread application of this technology could result in 50,000 additional survivors per year.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Small Business Innovation Research Grants (SBIR) - Phase II (R44)
Project #
5R44HL065851-05
Application #
7188538
Study Section
Special Emphasis Panel (ZRG1-SBTS (10))
Program Officer
Desvigne-Nickens, Patrice
Project Start
2000-09-15
Project End
2010-01-31
Budget Start
2007-02-01
Budget End
2010-01-31
Support Year
5
Fiscal Year
2007
Total Cost
$1,014,996
Indirect Cost
Name
Advanced Circulatory Systems, Inc.
Department
Type
DUNS #
140320396
City
Roseville
State
MN
Country
United States
Zip Code
55113
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Aufderheide, Tom P; Frascone, Ralph J; Wayne, Marvin A et al. (2011) Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial. Lancet 377:301-11
Aufderheide, Tom P; Yannopoulos, Demetris; Lick, Charles J et al. (2010) Implementing the 2005 American Heart Association Guidelines improves outcomes after out-of-hospital cardiac arrest. Heart Rhythm 7:1357-62
Aufderheide, Tom P; Alexander, Carly; Lick, Charles et al. (2008) From laboratory science to six emergency medical services systems: New understanding of the physiology of cardiopulmonary resuscitation increases survival rates after cardiac arrest. Crit Care Med 36:S397-404
Salzman, Joshua G; Frascone, Ralph J; Godding, Bobette K et al. (2007) Implementing emergency research requiring exception from informed consent, community consultation, and public disclosure. Ann Emerg Med 50:448-55, 455.e1-4
Aufderheide, Tom P; Pirrallo, Ronald G; Yannopoulos, Demetris et al. (2006) Incomplete chest wall decompression: a clinical evaluation of CPR performance by trained laypersons and an assessment of alternative manual chest compression-decompression techniques. Resuscitation 71:341-51
Aufderheide, Tom P; Lurie, Keith G (2006) Vital organ blood flow with the impedance threshold device. Crit Care Med 34:S466-73
Pirrallo, Ronald G; Aufderheide, Tom P; Provo, Terry A et al. (2005) Effect of an inspiratory impedance threshold device on hemodynamics during conventional manual cardiopulmonary resuscitation. Resuscitation 66:13-20
Aufderheide, Tom P; Pirrallo, Ronald G; Provo, Terry A et al. (2005) Clinical evaluation of an inspiratory impedance threshold device during standard cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest. Crit Care Med 33:734-40

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