Does impedance threshold device therapy have a place in the treatment of increased intracranial pressure in pre-hospital patients? A literature review

Hypotension and raised intercranial pressure are well-known poor prognostic indicators in patients suffering traumatic brain injuries based on the combined benefits of the impedance threshold device in increasing mean atrial blood pressure and decreasing intercranial pressure. The evidence presented in this literature search presents devices which create subatmospheric intrathoracic pressure, such as ResQGARD, as viable opportunities to rapidly lower intercranial pressure and raise cerebral perfusion pressure using safe non-invasive therapeutic interventions in traumatic brain injuries. The use of intrathoracic pressure regulators in intubated and mechanically ventilated inpatients has already been assessed in a pilot study, which indicated positive effects on intercranial pressure and cerebral perfusion pressure. There now exists a clear need for a proof of clinical concept study to show that application of an impedance threshold device can be used as a safe and effective non-invasive method to increase cerebral perfusion pressure and decrease intercranial pressure in spontaneously breathing patients with raised intercranial pressure following traumatic brain injuries in a pre-hospital setting.