Voelcker Academy

Research Symposium 2011

 

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Jacob Larrumbide

An Impedance Threshold Device Improves Systolic Blood Pressure in Prehospital Hypotensive Patients

Jacob Larrumbide

Mentor(s): Craig Manifold, DO & David Wampler, PhD

Funded by the military, the RES-Q-GARD® (Advanced Circulatory Systems, Minneapolis, MN) is a device that is used to increase blood pressure during hypotension from a variety of causes. Although not used on a larger scale yet, this Impedance threshold device (ITD) was distributed for a pilot study to paramedic teams for use in hypotensive patients.
 

A six-month prospective, non-randomized, observation study was conducted to identify a change in vital signs following paramedic application of the ITD in prehospital hypotensive patient. All SAFD paramedics were trained in the use of the device, with training reinforced by the video that was created by our department to ensure that the device is used properly to achieve the best results. Secondary outcomes include patient tolerance and paramedic perception of the patient’s tolerance.
 

During the study period, 200 subjects were recruited with a mean initial blood pressure of 78/50 and a heart rate of 87 beats per minute. After the paramedic treatment, utilizing the ITD, the mean blood pressure rose to 97/63 with no change in heart rate. This showed significant improvement in the patients’ condition. Of the 200 hypotensive subjects, 29 were identified as a trauma mechanism of injury and this population showed a significant increase in mean systolic blood pressure from 80 to 103 systolic, and 56 to 71 diastolic. There was no significant change in the mean heart rate from 89 to 80.
 

In conclusion, the ITD was easily assimilated into the standard tools and equipment used to treat hypotensive patients. A significant increase in blood pressure was observed. For the trauma cohort, the RES-Q-GARD® device did not restore normal blood pressure to the patient, but did improve it from critical levels. This is a specifically important concept with respect to permissive hypotension; a concept that the military is specifically interested in the traumatized warrior. Patients tolerated the device well.

Collaborators: Jacob Larrumbide, Dr. Craig Manifold, Dr. Victor Convertino, Shannon Weeks, & Dr. David Wampler