Resqpod Research Papers

1. Cooper JA, Cooper JD, Cooper JM. Cardiopulmonary resuscitation: history, current practice, and future direction. Circulation. 2006;114:2839–2849.[PubMed]

2. Nakagawa Y, Weil MH, Tang W. The history of CPR. In: Weil MH, Tang W, eds , editors. CPR: Resuscitation of the Arrested Heart. Philadelphia, Pa: WB Saunders Company; 1999. p. 4.

3. Szmuk P, Ezri T, Evron S, Roth Y, Katz J. A brief history of tracheostomy and tracheal intubation, from the Bronze Age to the Space Age. Intensive Care Med. 2008;34:222–228.[PubMed]

4. Vesalius A. De humani corporis fabrica libri septem. Basileae: Ex officina Joannis Oporini; 1543.

5. Alzaga AG, Varon J, Baskett P. The resuscitation greats. Charles Kite: The clinical epidemiology of sudden cardiac death and the origin of the early defibrillator. Resuscitation. 2005;64:7–12.[PubMed]

6. Baskett TF. Resuscitation greats: Marshall Hall and his ready method of resuscitation. Resuscitation. 2003;57:227–230.[PubMed]

7. Safar P, Escarraga LA, Chang F. Upper airway obstruction in the unconscious patient. J Appl Physiol. 1959;14:760–764.[PubMed]

8. Safar P, McMahon M. Mouth-to-airway emergency artificial respiration. J Am Med Assoc. 1958;166:1459–1460.[PubMed]

9. Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed-chest cardiac massage. JAMA. 1960;173:1064–1067.[PubMed]

10. Horsted TI, Rasmussen LS, Meyhoff CS, Nielsen SL. Long-term prognosis after out-of-hospital cardiac arrest. Resuscitation. 2007;72:214–218.[PubMed]

11. Dunne RB, Compton S, Zalenski RJ, Swor R, Welch R, Bock BF. Outcomes from out-of-hospital cardiac arrest in Detroit. Resuscitation. 2007;72:59–65.[PubMed]

12. Cobb LA, Fahrenbruch CE, Olsufka M, Copass MK. Changing incidence of out-of-hospital ventricular fibrillation, 1980-2000. JAMA. 2002;288:3008–3013.[PubMed]

13. Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation. 2001;104:2158–2163.[PubMed]

14. Stephenson HE Jr, Reid LC, Hinton JW. Some common denominators in 1200 cases of cardiac arrest. Ann Surg. 1953;137:731–744.[PMC free article][PubMed]

15. Beck CS, Pritchard WH, Feil HS. Ventricular fibrillation of long duration abolished by electric shock. JAMA. 1947;135:985–986.[PubMed]

16. Lurie K, Sukhum P, Voelckel W, Zielinski T, Plaisance P. Recent advances in mechanical cardiopulmonary resuscitation devices. Curr Opin Crit Care. 1999;5:184–192.

17. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 6: CPR techniques and devices. Circulation. 2005;112:IV–47-IV-50.

18. Xanthos T, Lelovas P, Vlachos I, Tsirikos-Karapanos N, Kouskouni E, Perrea D, Dontas I. Cardiopulmonary arrest and resuscitation in Landrace/Large White swine: a research model. Lab Anim. 2007;41:353–362.[PubMed]

19. Sanders AB, Ogle M, Ewy GA. Coronary perfusion pressure during cardiopulmonary resuscitation. Am J Emerg Med. 1985;3:11–14.[PubMed]

20. Ralston SH, Voorhees WD, Babbs CF. Intrapulmonary epinephrine during prolonged cardiopulmonary resuscitation: improved regional blood flow and resuscitation in dogs. Ann Emerg Med. 1984;13:79–86.[PubMed]

21. Michael JR, Guerci AD, Koehler RC, Shi AY, Tsitlik J, Chandra N, Niedermeyer E, Rogers MC, Traystman RJ, Weisfeldt ML. Mechanisms by which epinephrine augments cerebral and myocardial perfusion during cardiopulmonary resuscitation in dogs. Circulation. 1984;69:822–835.[PubMed]

22. Kitakaze M, Marban E. Cellular mechanism of the modulation of contractile function by coronary perfusion pressure in ferret hearts. J Physiol. 1989;414:455–472.[PMC free article][PubMed]

23. Niemann JT, Rosborough JP, Niskanen RA, Alferness C, Criley JM. Mechanical "cough" cardiopulmonary resuscitation during cardiac arrest in dogs. Am J Cardiol. 1985;55:199–204.[PubMed]

24. Feneley MP, Maier GW, Kern KB, Gaynor JW, Gall SA Jr, Sanders AB, Raessler K, Muhlbaier LH, Rankin JS, Ewy GA. Influence of compression rate on initial success of resuscitation and 24 hour survival after prolonged manual cardiopulmonary resuscitation in dogs. Circulation. 1988;77:240–250.[PubMed]

25. Kern KB, Sanders AB, Badylak SF, Janas W, Carter AB, Tacker WA, Ewy GA. Long-term survival with open-chest cardiac massage after ineffective closed-chest compression in a canine preparation. Circulation. 1987;75:498–503.[PubMed]

26. Schleien CL, Berkowitz ID, Traystman R, Rogers MC. Controversial issues in cardiopulmonary resuscitation. Anesthesiology. 1989;71:133–149.[PubMed]

27. Jude JR, Kouwenhoven WB, Knickerbocker GG. Cardiac arrest. Report of application of external cardiac massage on 118 patients. JAMA. 1961;178:1063–1070.[PubMed]

28. Rudikoff MT, Maughan WL, Effron M, Freund P, Weisfeldt ML. Mechanisms of blood flow during cardiopulmonary resuscitation. Circulation. 1980;61:345–352.[PubMed]

29. Lurie KG, Mulligan KA, McKnite S, Detloff B, Lindstrom P, Lindner KH. Optimizing standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve. Chest. 1998;113:1084–1090.[PubMed]

30. Shultz JJ, Coffeen P, Sweeney M, Detloff B, Kehler C, Pineda E, Yakshe P, Adler SW, Chang M, Lurie KG. Evaluation of standard and active compression-decompression CPR in an acute human model of ventricular fibrillation. Circulation. 1994;89:684–693.[PubMed]

31. Yannopoulos D, Aufderheide TP, Gabrielli A, Beiser DG, McKnite SH, Pirrallo RG, Wigginton J, Becker L, Vanden Hoek T, Tang W, et al. Clinical and hemodynamic comparison of 15:2 and 30:2 compression-to-ventilation ratios for cardiopulmonary resuscitation. Crit Care Med. 2006;34:1444–1449.[PubMed]

32. Yannopoulos D, Sigurdsson G, McKnite S, Benditt D, Lurie KG. Reducing ventilation frequency combined with an inspiratory impedance device improves CPR efficiency in swine model of cardiac arrest. Resuscitation. 2004;61:75–82.[PubMed]

33. Yannopoulos D, McKnite S, Aufderheide TP, Sigurdsson G, Pirrallo RG, Benditt D, Lurie KG. Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest. Resuscitation. 2005;64:363–372.[PubMed]

34. Berne RM, Levy MN. Cardiovascular physiology. 2st ed. St. Louis: CV Mosby; 1997. p. 216.

35. Plaisance P, Soleil C, Ducros L, Lurie K, Vicaut E, Payen D. Measurement of intrathoracic pressures during basic and advanced cardiac life support while performing active compression decompression cardiopulmonary resuscitation with an inspiratory imped- ance threshold valve. Crit Care Med. 2001;29:A73.

36. Lurie KG, Coffeen P, Shultz J, McKnite S, Detloff B, Mulligan K. Improving active compression-decompression cardiopulmonary resuscitation with an inspiratory impedance valve. Circulation. 1995;91:1629–1632.[PubMed]

37. Carli PA, De La Coussaye JE, Riou B, Sassine A, Eledjam JJ. Ventilatory effects of active compression-decompression in dogs. Ann Emerg Med. 1994;24:890–894.[PubMed]

38. Plaisance P, Soleil C, Lurie KG, Vicaut E, Ducros L, Payen D. Use of an inspiratory impedance threshold device on a facemask and endotracheal tube to reduce intrathoracic pressures during the decompression phase of active compression-decompression cardiopulmonary resuscitation. Crit Care Med. 2005;33:990–994.[PubMed]

39. Wigginton JG, Miller AH, Benitez FL, Pepe PE. Mechanical devices for cardiopulmonary resuscitation. Curr Opin Crit Care. 2005;11:219–223.[PubMed]

40. Frascone RJ, Bitz D, Lurie K. Combination of active compression decompression cardiopulmonary resuscitation and the inspiratory impedance threshold device: state of the art. Curr Opin Crit Care. 2004;10:193–201.[PubMed]

41. Lurie KG, Voelckel WG, Zielinski T, McKnite S, Lindstrom P, Peterson C, Wenzel V, Lindner KH, Samniah N, Benditt D. Improving standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve in a porcine model of cardiac arrest. Anesth Analg. 2001;93:649–655.[PubMed]

42. Lurie KG, Zielinski T, McKnite S, Aufderheide T, Voelckel W. Use of an inspiratory impedance valve improves neurologically intact survival in a porcine model of ventricular fibrillation. Circulation. 2002;105:124–129.[PubMed]

43. Langhelle A, Strømme T, Sunde K, Wik L, Nicolaysen G, Steen PA. Inspiratory impedance threshold valve during CPR. Resuscitation. 2002;52:39–48.[PubMed]

44. Raedler C, Voelckel WG, Wenzel V, Bahlmann L, Baumeier W, Schmittinger CA, Herff H, Krismer AC, Lindner KH, Lurie KG. Vasopressor response in a porcine model of hypothermic cardiac arrest is improved with active compression-decompression cardiopulmonary resuscitation using the inspiratory impedance threshold valve. Anesth Analg. 2002;95:1496–1502, table of contents.[PubMed]

45. Srinivasan V, Nadkarni VM, Yannopoulos D, Marino BS, Sigurdsson G, McKnite SH, Zook M, Benditt DG, Lurie KG. Rapid induction of cerebral hypothermia is enhanced with active compression-decompression plus inspiratory impedance threshold device cardiopulmonary resusitation in a porcine model of cardiac arrest. J Am Coll Cardiol. 2006;47:835–841.[PubMed]

46. Metzger A, Herman ML, McKnite SH, Yannopoulos D, Lurie KG. Effect of an impedance threshold device and a novel active compression decompression cardiopulmonary resuscitation device on cerebral perfusion pressures and 24-hour neurological survival in a porcine model of cardiac arrest. Circulation. 2006;114:II–554.

47. Yannopoulos D, Halperin HR, Lurie KG. Lower extremity counterpulsation during the decompression phase of CPR improves hemodynamics and provides continuous forward carotid blood flow. Circulation. 2007;116 Suppl II:II–485.

48. Alexander C, Yannopoulos D, Aufderheide TP, McKnite S, Matsuura T, Metzger A, Lurie K. Dual mechanism of blood flow augmentation to the brain using an impedance threshold device in a pediatric model of cardiac arrest. Circulation. 2007;116 Suppl II:II–433.

49. Yannopoulos D, McKnite SH, Metzger A, Lurie KG. Intrathoracic pressure regulation for intracranial pressure management in normovolemic and hypovolemic pigs. Crit Care Med. 2006;34:S495–S500.[PubMed]

50. Voelckel WG, Lurie KG, Sweeney M, McKnite S, Zielinski T, Lindstrom P, Peterson C, Wenzel V, Lindner KH. Effects of active compression-decompression cardiopulmonary resuscitation with the inspiratory threshold valve in a young porcine model of cardiac arrest. Pediatr Res. 2002;51:523–527.[PubMed]

51. Bahlmann L, Klaus S, Baumeier W, Schmucker P, Raedler C, Schmittinger CA, Wenzel V, Voelckel W, Lindner KH. Brain metabolism during cardiopulmonary resuscitation assessed with microdialysis. Resuscitation. 2003;59:255–260.[PubMed]

52. Matsuura TR, McKnite SH, Metzger AK, Yannopoulos D, Aufderheide TP, Lurie KG. An impedance threshold device combined with an automated active compression decompression CPR device (LUCAS) improves the chances for survival in pigs in cardiac arrest. Circulation. 2008;118:S1449–S1450.

53. Vartanian L, Wolf G, Sims A, Traynor K, Cypress Creek EMS, Spring TX. Use of an impedance threshold device improves survival in a suburban EMS system. Circulation. 2006;114:II–1209.

54. Aufderheide TP, Birnbaum M, Lick C, Myers B, Romig L, Stothert J, Vartanian L, Cypress Creek TX. A tale of seven EMS systems: an impedance threshold device and improved CPR techniques double survival rates after out-of-hospital cardiac arrest. Circulation. 2007;116 Suppl II:II–936.

55. Plaisance P, Lurie KG, Payen D. Inspiratory impedance during active compression-decompression cardiopulmonary resuscitation: a randomized evaluation in patients in cardiac arrest. Circulation. 2000;101:989–994.[PubMed]

56. Wolcke BB, Mauer DK, Schoefmann MF, Teichmann H, Provo TA, Lindner KH, Dick WF, Aeppli D, Lurie KG. Comparison of standard cardiopulmonary resuscitation versus the combination of active compression-decompression cardiopulmonary resuscitation and an inspiratory impedance threshold device for out-of-hospital cardiac arrest. Circulation. 2003;108:2201–2205.[PubMed]

57. Pirrallo RG, Aufderheide TP, Provo TA, Lurie KG. Effect of an inspiratory impedance threshold device on hemodynamics during conventional manual cardiopulmonary resuscitation. Resuscitation. 2005;66:13–20.[PubMed]

58. Thigpen K, Simmons L, Hatten K. Implementation of the 2005 Cardiopulmonary Resuscitation Guidelines and use of an impedance threshold device improve survival from inhospital cardiac arrest. Ann Emerg Med. 2008;51:475.

59. Aufderheide TP, Pirrallo RG, Provo TA, Lurie KG. Clinical evaluation of an inspiratory impedance threshold device during standard cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest. Crit Care Med. 2005;33:734–740.[PubMed]

60. Thayne RC, Thomas DC, Neville JD, Van Dellen A. Use of an impedance threshold device improves short-term outcomes following out-of-hospital cardiac arrest. Resuscitation. 2005;67:103–108.[PubMed]

61. Davis S, Thigpen K, Basol R, Aufderheide T. Implementation of the 2005 AHA guidelines together with the ITD improves hospital discharge rates after in-hospital cardiac arrest. Circulation. 2008;118:S765.

62. Plaisance P, Lurie KG, Vicaut E, Martin D, Gueugniaud PY, Petit JL, Payen D. Evaluation of an impedance threshold device in patients receiving active compression-decompression cardiopulmonary resuscitation for out of hospital cardiac arrest. Resuscitation. 2004;61:265–271.[PubMed]

63. Lurie K, Steinkamp J, Lick C, Aufderheide T, Sayre M, White L, Racht E, Gonzales L, Nygaard S, Niskanen R. Take Heart America™: A community-based sudden cardiac arrest survival initiative is saving lives by implementing the most highly recommended 2005 American Heart Association resuscitation guidelines. Circulation. 2008;118:S1464.

64. Cabrini L, Beccaria P, Landoni G, Biondi-Zoccai GG, Sheiban I, Cristofolini M, Fochi O, Maj G, Zangrillo A. Impact of impedance threshold devices on cardiopulmonary resuscitation: a systematic review and meta-analysis of randomized controlled studies. Crit Care Med. 2008;36:1625–1632.[PubMed]

65. Mader TJ, Kellogg AR, Smith J, Hynds-Decoteau R, Gaudet C, Caron J, Murphy B, Paquette A, Sherman LD. A blinded, randomized controlled evaluation of an impedance threshold device during cardiopulmonary resuscitation in swine. Resuscitation. 2008;77:387–394.[PubMed]

66. Menegazzi JJ, Salcido DD, Menegazzi MT, Rittenberger JC, Suffoletto BP, Logue ES, Mader TJ. Effects of an impedance threshold device on hemodynamics and restoration of spontaneous circulation in prolonged porcine ventricular fibrillation. Prehosp Emerg Care. 2007;11:179–185.[PubMed]

67. Herff H, Raedler C, Zander R, Wenzel V, Schmittinger CA, Brenner E, Rieger M, Lindner KH. Use of an inspiratory impedance threshold valve during chest compressions without assisted ventilation may result in hypoxaemia. Resuscitation. 2007;72:466–476.[PubMed]

68. Yannopoulos D, Aufderheide TP. Use of the Impedance Threshold Device (ITD) Resuscitation. 2007;75:192–193; author reply 193-194.[PubMed]

Does the ResQPOD Circulatory Enhancer comply with International Standard Organization (ISO) anaesthetic connection standards?
Yes, the ResQPOD is in full compliance of ISO 5356-1, Anaesthetic and respiratory equipment – conical connectors.
What effect does adding a PEEP valve to the ventilation circuit (distal or proximal) have on the ResQPOD Circulatory Enhancer?
PEEP is compatible with the ResQPOD. If it is used, it should be placed between the ResQPOD and the ventilation source, not between the ResQPOD and the airway. One animal study has shown that low levels of PEEP may improve the efficiency of CPR with the ResQPOD 11 , but there are no human studies evaluating both the ResQPOD and PEEP to date.

What effect does adding continuous positive airway pressure (CPAP) to the ventilation circuit (distal or proximal) have on the ResQPOD?
CPAP is not compatible with the ResQPOD because it is not possible to lower intrathoracic pressure with CPAP. CPAP is contraindicated during CPR as it decreases venous blood flow back to the heart. CPAP should not be used during the performance of CPR, with or without the ResQPOD.

What effect does adding bi-level positive airway pressure (BiPAP) to the ventilation circuit (distal or proximal) have on the ResQPOD Circulatory Enhancer?
BiPAP is not compatible with the ResQPOD because any continuous positive airway pressure ventilation negates most of the effects of the ResQPOD during cardiac arrest.

Can I use the ResQPOD Circulatory Enhancer with a colormetric end tidal carbon dioxide (ETCO2) detector in the ventilation circuit to assess endotracheal (ET) tube placement or with a bag-valve resuscitator that incorporates ETCO2 detection as a feature (e.g. Capno-Flo [Mallinkrodt])?
Yes. The colormetric test results may be more positive with the ResQPOD in place if the ET is in the proper position. Place the colormetric ETCO2 detector between the ResQPOD and the ventilation source, making sure all connections are tight and do not leak.

Can I use electronic ETCO2 detection (with sidestream or mainstream gas sampling) in the same ventilation circuit as the ResQPOD Circulatory Enhancer?
Yes, as long as the sensor is placed between the ResQPOD and the ventilation source and not between the ResQPOD and the airway, which could create an air leak and, therefore, hinder the development of the vacuum.

Can I use the ResQPOD Circulatory Enhancer with bag-valve resuscitators that have an integrated "mediport" (feature that permits administration of medications via a metered dose inhaler) or to administer medications endotracheally (e.g. Medibag, Ambu)?
Yes, the ResQPOD should not affect the delivery of the medication and the medication should not affect the performance of the ResQPOD. However, this has not been clinically tested and may depend upon the medication used. If you are delivering endotracheal medications without a mediport, the manufacturer recommends that you disconnect the ResQPOD from the endotracheal (ET) tube, administer the medications directly into the ET tube, and then reconnect the ResQPOD.

Can the ResQPOD Circulatory Enhancer be used with a bag-valve resuscitator with a feature that limits flow rates (and thus airflow pressures) during ventilation (e.g. SMART BAG)?
Yes. This feature will not affect the ResQPOD’s function.

Can I use the ResQPOD with the Oxylator?
No. In the automatic mode, the Oxylator provides a continuously positive airway pressure that is harmful for the patient, with or without the ResQPOD. This continuously positive airflow interferes with the ResQPOD’s ability to create a vacuum (negative pressure). ACSI and the American Heart Association discourage the use of the Oxylator in the automatic mode during CPR, it will decrease circulation.

Can the ResQPOD Circulatory Enhancer be used on a patient with a tracheostomy or stoma?
A patient with a stoma could have an endotracheal tube placed into the stoma for airway management. If there is not a good seal between the airway device and the lungs, the ResQPOD may be less effective. As long as there is an adequate seal during positive pressure ventilation, the ResQPOD should work effectively. It is the ultimate decision of the prescribing physician to determine in what ages of patients the ResQPOD should be used.

Can the ResQPOD Circulatory Enhancer be used on an uncuffed endotracheal tube?
If there is not a good seal between the airway device and the lungs, the ResQPOD may be less effective. As long as there is an adequate seal during positive pressure ventilation, the ResQPOD should work effectively. It is the ultimate decision of the prescribing physician to determine in what ages of patients the ResQPOD should be used.

Can the ResQPOD Circulatory Enhancer be used with any standard facemask?
Yes; however, the manufacturer strongly recommends that the user consider the quality of the facemask to use it with. Obtaining and maintaining an adequate seal during facemask ventilation is critically important to the generation of the all-important vacuum. Many standard facemasks purchased today are selected primarily based upon cost, not mask quality. ACSI recommends that anyone who is going to use the ResQPOD on a facemask use one with excellent face-sealing qualities. A 2-person ventilation technique, as recommended by the American Heart Association, is preferred.

The current model of ResQPOD requires a 15 mm/22 mm adaptor in order to attach it to a standard facemask; no adaptor is required for connection to an endotracheal tube. At the present time, the ResQPOD comes packaged with this adaptor. Sometime in the summer of 2005, the next model of ResQPOD will come out (same product number). This model will not require an adaptor for connection to any airway adjunct and will have two timing assist lights instead of three. A special sticker will be placed on the packaging so that the user will know that an adaptor is no longer required.

I see that the ResQPOD can be used for mouth-to-mask ventilation, but the ResQPOD doesn’t come packaged with a mouthpiece. How can I get one?
Most mouthpieces with standard adaptors will work. One source for mouthpieces that will work with the ResQPOD is: Qosina, 150-Q Executive Drive, Edgewood, NY 11717-8329; phone: 631-242-3000; fax: 631-242-3230; website: www.qosina.com; product name: 22 mm OD mouthpiece; part #: 55901.

Can I use the ResQPOD Circulatory Enhancer on a Combitube, laryngeal mask airway (LMA), esophageal obturator airway (EOA), Cobra, or other advanced airway?
The ResQPOD is cleared for use on airway adjuncts used during assisted ventilation. The ResQPOD will fit on these advanced airway devices and should be effective as long as there is a sufficient seal within the ventilation circuit.

Has the ResQPOD Circulatory Enhancer been tested with semi-open anesthetic circuits (e.g. Bain, McGill, Lack) as these are used in emergency resuscitation rooms connected to resuscitation machines?
The ResQPOD has not been tested in semi-open anesthetic circuits; however, there is no known reason that the ResQPOD should not work with these machines.

Has the ResQPOD Circulatory Enhancer been tested with Soda Lime Absorber “Closed Circuit” anesthetic systems, which are also used in resuscitation areas?
The ResQPOD has not been tested in closed circuit anesthetic systems; however, there is no reason to believe that the ResQPOD would not work.

When expiration release pressures are high, minute volume dividers and pressure-cycled resuscitators may respond with a high respiratory rate and low breath volumes. Most EMS ventilators and BVM devices can be fitted with a break valve pressure of between 45 and 60 cmH2O. Does this affect ResQPOD performance?
This should not alter the performance of the ResQPOD.

Does the application of cricoid pressure interfere with ResQPOD performance?
No.

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