Harnessing cardiopulmonary interactions to improve circulation and outcomes after cardiac arrest and other states of low blood pressure

Novel noninvasive technologies that harness the inherent physiological interactions between the heart, lungs, and brain have recently been shown to improve circulation and outcomes after cardiac arrest and other states of low blood pressure including hypovolemic shock. The impedance threshold devices (ResQPOD^® and ResQGard^®) and the intrathoracic pressure regulator (CirQlator™) are three new devices that create a negative intrathoracic pressure. The decrease in intrathoracic pressure creates a vacuum within the thorax relative to the rest of the body thereby enhancing venous blood return to the heart, increasing cardiac output and systemic arterial blood pressure, lowering right atrial and pulmonary artery pressures, lowering intracranial pressure, and increasing cerebral perfusion pressure. The animal and clinical data supporting the use of technologies that harness the intrathoraic pump are reviewed in this chapter.