Study Finds “Fluidless” Resuscitation Using Impedance Threshold Device Significantly Improves Systolic Blood Pressure and Pulse Pressure Following Excessive Blood Loss
Minneapolis, MN - Studies have shown that aggressive fluid administration in the treatment of hypotension following traumatic injury can dilute the blood of clotting factors (hemodilution) and also dislodge early forming clots due to overpressure within the blood vessels. An alternative approach to improving outcomes in traumatic injury and hemorrhagic shock is “permissive hypotension,” which proactively maintains systolic blood pressure (SBP) at a level slightly lower than normal, but high enough to maintain blood flow to vital organs.
Supporting this practice, a study1 published in the recent issue of the Journal of Trauma and Acute Care Surgery found that, compared to controls that received no treatment or aggressive fluid resuscitation with normal saline, negative intrathoracic pressure regulation using the ResQGARD Impedance Threshold Device (ITD) significantly improved SBP and pulse pressure without hemodilution and without exceeding blood pressures typically associated with “popping the clot”.
This study set out to examine how fluidless resuscitation with permissive hypotension via the ResQGARD ITD compares to normal saline resuscitation in cases of severe hemorrhage. The article, “Fluidless” resuscitation with permissive hypotension via impedance threshold device therapy compared with normal saline resuscitation in a porcine model of severe hemorrhage by Anja Metzger, PhD, et al, found that:
- Negative intrathoracic pressure regulation with an ITD significantly improved hemodynamic parameters and provided permissive hypotension compared with untreated controls.
- After enhancement of negative intrathoracic pressure with an ITD, the maximal SBP did not exceed baseline values and did not result in arterial blood pressures associated with clot disruption.
- Conventional fluid resuscitation resulted in a rapid elevation in SBP to levels considered dangerously high in the setting of acute trauma and hemorrhage.
- Animals receiving intravascular normal saline fluid replacement experienced significant hemodilution and a significantly higher intracranial pressure compared with subjects treated with an ITD, or untreated control subjects.
- Fluid resuscitation with normal saline but no ITD resulted in a significant rise in SBP that could cause a further reduction in hematocrit and clot dislodgement.
The authors noted: “The benefits associated with harnessing inspiratory efforts with nITP therapy provide a novel way to deliver permissive hypotension, thus avoiding the potential adverse effects of early aggressive resuscitation.”
This study further validates the use of technologies that provide Perfusion of DemandTM, such as the ResQGARD® ITD developed by Advanced Circulatory of Minneapolis. Used in spontaneously breathing patients with poor perfusion, the ResQGARD is a non-invasive device that treats low blood pressure in patients who are hypotensive due to shock from a variety of causes (e.g. blood loss, dehydration, sepsis, dialysis, heat shock). The ResQGARD provides therapeutic benefit as soon as a patient begins to breathe through it. Studies have shown that the ResQGARD increases blood pressure during hypotension by up to 30% or more. The ResQGARD is FDA 510(k) cleared; CE marked and is patent protected globally.
Advanced Circulatory is the pioneer of a novel perfusion therapy platform with far-reaching implications for multiple medical conditions. This non-invasive therapy increases circulation, protecting the heart, brain and other vital organs when blood flow is compromised, giving rescuers, clinicians and caregivers the potential to return patients to a full life after critical medical emergencies. The company’s products are sold in over 25 countries worldwide.