Use of an impedance threshold device to treat

prehospital hypotension
Paul A. Satterlee, MD, Jonathan W. Kamrud, NREMT-P, Lori L. Boland, MPH, Charles J. Lick, MD
Allina Health Emergency Medical Services, St. Paul, MN

METHODS (cont.)

RESULTS (cont.)

Data Collection
Prehospital records reviewed by a single paramedic
Pre-ITD value = last value recorded by paramedics
prior to ITD placement
Post-ITD value = first value recorded by
paramedics after ITD placement

Table 2: Mean vital sign values in 147 patients before and

after placement of ITD by paramedics, overall and by
receipt of prehospital fluids

Variable

RESULTS
BACKGROUND
 rehospital providers have few options for treating
P
hypotension
Non-invasive impedance threshold devices (ITD) have
been shown to increase blood pressure in patients
exhibiting hypotension
Limited research has been conducted on the
effectiveness of using an ITD in the prehospital setting to
treat hypotension
Our ALS ambulance service introduced an ITD in 2011
for use in the treatment of hypotension in patients with
spontaneous respiration

OBJECTIVES
 escribe the clinical conditions with associated
D
hypotension for which paramedics have used the ITD
Examine prehospital values of heart rate (HR), respiratory
rate (RR), systolic blood pressure (SBP), and diastolic
blood pressure (DBP) before and after ITD placement
Describe our experience with patient tolerance of
the ITD

METHODS
Setting & Design
Large ambulance service in Minnesota
Retrospective case series of all ITD uses in 2011-2013
ITD used to treat hypotension in patients with
spontaneous respiration
Patients 18 years of age

111023 1214 2014 ALLINA HEALTH SYSTEM. TM A TRADEMARK OF ALLINA HEALTH SYSTEM.

 47 device uses reviewed

1
The most common etiologies were syncope and
weakness
Among 70 patients for whom device tolerance was
documented, 23% required device removal.
On average, SBP increased 15 mmHg, and DBP
increased 9 mmHg with ITD placement.
Observed increases in blood pressure were
independent of administration of prehospital
intravenous fluids.
Table 1: Patient and event characteristics in 147 prehospital
uses of ITD for hypotension

Variable
Age, y
Male
Received prehospital IV Fluids
Etiology
Syncope
Weakness
Unknown
Hemorrhage Non-Trauma
Other
Dehydration
Sepsis
Overdose
Intra or Post Dialysis
Hemorrhage Trauma
Patient Tolerance
Intolerance, device removed
Intolerance, use continued
Tolerated
Unable to determine
Results presented as mean (SD) or % (n)

Mean
Mean
Mean
p-Valuea
Pre-ITD Post-ITD Change

SBP (mmHg)

77

93

+15.4 <0.0001

DBP (mmHg)
Mean Arterial
Pressure (mmHg)
Heart Rate (bpm)

45

55

+9.1 <0.0001

56

67

+11.2 <0.0001

86

85

0.242

Respiratory Rate (pm)

19

18

0.799

Mean BP Change by Receipt

of Prehospital IV Fluids

Mean
p-Valuea
Change

SBP (mmHg)
Fluids
No Fluids

+15.1
+15.6

0.88b

DBP (mmHg)
Fluids
No Fluids

+8.8
+9.4

0.85b

Mean Arterial Pressure (mmHg)

Fluids
No Fluids

+11.0
+11.4

0.91b

p-value for paired samples t-test or Wilcoxon signed-rank test unless otherwise
noted; bp-value for independent samples t-test
a

66.5 (16)
48% (70)
42% (62)
27% (39)
16% (23)
15% (22)
11% (16)
10% (14)
10% (14)
5% (7)
4% (6)
3% (5)
1% (1)
11% (16)
10% (14)
27% (40)
52% (77)

LIMITATIONS
L ack of standardization of vital sign intervals or
documentation about ITD tolerance
No control group of similar patients who did not
receive ITD
No covariate adjustment
Device use was at the discretion of the clinician

CONCLUSIONS
Use of this ITD increased blood pressure
independent of the traditional intervention
of intravenous fluid infusion in patients with
hypotension from a variety of clinical conditions.
The ITD was well-tolerated in the majority of the
patients for whom device tolerance was
documented.