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1. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

Author

Berg, K. M., Bray, J. E., Ng, K. -C., Liley, H. G., Greif, R., Carlson, J. N., Morley, P. T., Drennan, I. R., Smyth, M., Scholefield, B. R., Weiner, G. M., Cheng, A., Djarv, T., Abelairas-Gomez, C., Acworth, J., Andersen, L. W., Atkins, D. L., Berry, D. C., Bhanji, F., Bierens, J., Couto, T. B., Borra, V., Bottiger, B. W., Bradley, R. N., Breckwoldt, J., Cassan, P., Chang, W. -T., Charlton, N. P., Chung, S. P., Considine, J., Costa-Nobre, D. T., Couper, K., Dainty, K. N., Dassanayake, V., Davis, P. G., Dawson, J. A., de Almeida, M. F., De Caen, A. R., Deakin, C. D., Dicker, B., Douma, M. J., Eastwood, K., El-Naggar, W., Fabres, J. G., Fawke, J., Fijacko, N., Finn, J. C., Flores, G. E., Foglia, E. E., Folke, F., Gilfoyle, E., Goolsby, C. A., Granfeldt, A., Guerguerian, A. -M., Guinsburg, R., Hatanaka, T., Hirsch, K. G., Holmberg, M. J., Hosono, S., Hsieh, M. -J., Hsu, C. H., Ikeyama, T., Isayama, T., Johnson, N. J., Kapadia, V. S., Kawakami, M. D., Kim, H. -S., Kleinman, M. E., Kloeck, D. A., Kudenchuk, P., Kule, A., Kurosawa, H., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lee, H. C., Lin, Y., Lockey, A. S., Macneil, F., Maconochie, I. K., Madar, R. J., Hansen, C. M., Masterson, S., Matsuyama, T., Mckinlay, C. J. D., Meyran, D., Monnelly, V., Nadkarni, V., Nakwa, F. L., Nation, K. J., Nehme, Z., Nemeth, M., Neumar, R. W., Nicholson, T., Nikolaou, N., Nishiyama, C., Norii, T., Nuthall, G. A., Ohshimo, S., Olasveengen, T. M., Ong, Y. -K. G., Orkin, A. M., Parr, M. J., Patocka, C., Perkins, G. D., Perlman, J. M., Rabi, Y., Raitt, J., Ramachandran, S., Ramaswamy, V. V., Raymond, T. T., Reis, A. G., Reynolds, J. C., Ristagno, G., Rodriguez-Nunez, A., Roehr, C. C., Rudiger, M., Sakamoto, T., Sandroni, Claudio, Sawyer, T. L., Schexnayder, S. M., Schmolzer, G. M., Schnaubelt, S., Semeraro, F., Singletary, E. M., Skrifvars, M. B., Smith, C. M., Soar, J., Stassen, W., Sugiura, T., Tijssen, J. A., Topjian, A. A., Trevisanuto, D., Vaillancourt, C., Wyckoff, M. H., Wyllie, J. P., Yang, C. -W., Yeung, J., Zelop, C. M., Zideman, D. A., Nolan, J. P., Barcala-Furelos, R., Beerman, S. B., Bruckner, M., Castren, M., Chong, S., Claesson, A., Dunne, C. L., Finan, E., Fukuda, T., Ganesan, S. L., Gately, C., Gois, A., Gray, S., Halamek, L. P., Hoover, A. V., Hurst, C., Josephsen, J., Kollander, L., Kamlin, C. O., Kool, M., Li, L., Mecrow, T. S., Montgomery, W., Ristau, P., Jayashree, M., Schmidt, A., Scquizzato, T. -M., Seesink, J., Sempsrott, J., Solevag, A. L., Strand, M. L., Szpilman, D., Szyld, E., Thom, O., Tobin, J. M., Trang, J., Webber, J., Webster, H. K., Wellsford, M., Sandroni C. (ORCID:0000-0002-8878-2611), Berg, K. M., Bray, J. E., Ng, K. -C., Liley, H. G., Greif, R., Carlson, J. N., Morley, P. T., Drennan, I. R., Smyth, M., Scholefield, B. R., Weiner, G. M., Cheng, A., Djarv, T., Abelairas-Gomez, C., Acworth, J., Andersen, L. W., Atkins, D. L., Berry, D. C., Bhanji, F., Bierens, J., Couto, T. B., Borra, V., Bottiger, B. W., Bradley, R. N., Breckwoldt, J., Cassan, P., Chang, W. -T., Charlton, N. P., Chung, S. P., Considine, J., Costa-Nobre, D. T., Couper, K., Dainty, K. N., Dassanayake, V., Davis, P. G., Dawson, J. A., de Almeida, M. F., De Caen, A. R., Deakin, C. D., Dicker, B., Douma, M. J., Eastwood, K., El-Naggar, W., Fabres, J. G., Fawke, J., Fijacko, N., Finn, J. C., Flores, G. E., Foglia, E. E., Folke, F., Gilfoyle, E., Goolsby, C. A., Granfeldt, A., Guerguerian, A. -M., Guinsburg, R., Hatanaka, T., Hirsch, K. G., Holmberg, M. J., Hosono, S., Hsieh, M. -J., Hsu, C. H., Ikeyama, T., Isayama, T., Johnson, N. J., Kapadia, V. S., Kawakami, M. D., Kim, H. -S., Kleinman, M. E., Kloeck, D. A., Kudenchuk, P., Kule, A., Kurosawa, H., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lee, H. C., Lin, Y., Lockey, A. S., Macneil, F., Maconochie, I. K., Madar, R. J., Hansen, C. M., Masterson, S., Matsuyama, T., Mckinlay, C. J. D., Meyran, D., Monnelly, V., Nadkarni, V., Nakwa, F. L., Nation, K. J., Nehme, Z., Nemeth, M., Neumar, R. W., Nicholson, T., Nikolaou, N., Nishiyama, C., Norii, T., Nuthall, G. A., Ohshimo, S., Olasveengen, T. M., Ong, Y. -K. G., Orkin, A. M., Parr, M. J., Patocka, C., Perkins, G. D., Perlman, J. M., Rabi, Y., Raitt, J., Ramachandran, S., Ramaswamy, V. V., Raymond, T. T., Reis, A. G., Reynolds, J. C., Ristagno, G., Rodriguez-Nunez, A., Roehr, C. C., Rudiger, M., Sakamoto, T., Sandroni, Claudio, Sawyer, T. L., Schexnayder, S. M., Schmolzer, G. M., Schnaubelt, S., Semeraro, F., Singletary, E. M., Skrifvars, M. B., Smith, C. M., Soar, J., Stassen, W., Sugiura, T., Tijssen, J. A., Topjian, A. A., Trevisanuto, D., Vaillancourt, C., Wyckoff, M. H., Wyllie, J. P., Yang, C. -W., Yeung, J., Zelop, C. M., Zideman, D. A., Nolan, J. P., Barcala-Furelos, R., Beerman, S. B., Bruckner, M., Castren, M., Chong, S., Claesson, A., Dunne, C. L., Finan, E., Fukuda, T., Ganesan, S. L., Gately, C., Gois, A., Gray, S., Halamek, L. P., Hoover, A. V., Hurst, C., Josephsen, J., Kollander, L., Kamlin, C. O., Kool, M., Li, L., Mecrow, T. S., Montgomery, W., Ristau, P., Jayashree, M., Schmidt, A., Scquizzato, T. -M., Seesink, J., Sempsrott, J., Solevag, A. L., Strand, M. L., Szpilman, D., Szyld, E., Thom, O., Tobin, J. M., Trang, J., Webber, J., Webster, H. K., Wellsford, M., and Sandroni C. (ORCID:0000-0002-8878-2611)

Abstract

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

Published
2023

2. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group

Author

Wyckoff, M. H., Singletary, E. M., Soar, J., Olasveengen, T. M., Greif, R., Liley, H. G., Zideman, D., Bhanji, F., Andersen, L. W., Avis, S. R., Aziz, K., Bendall, J. C., Berry, D. C., Borra, V., Bottiger, B. W., Bradley, R., Bray, J. E., Breckwoldt, J., Carlson, J. N., Cassan, P., Castren, M., Chang, W. -T., Charlton, N. P., Cheng, A., Chung, S. P., Considine, J., Costa-Nobre, D. T., Couper, K., Dainty, K. N., Davis, P. G., de Almeida, M. F., de Caen, A. R., de Paiva, E. F., Deakin, C. D., Djarv, T., Douma, M. J., Drennan, I. R., Duff, J. P., Eastwood, K. J., El-Naggar, W., Epstein, J. L., Escalante, R., Fabres, J. G., Fawke, J., Finn, J. C., Foglia, E. E., Folke, F., Freeman, K., Gilfoyle, E., Goolsby, C. A., Grove, A., Guinsburg, R., Hatanaka, T., Hazinski, M. F., Heriot, G. S., Hirsch, K. G., Holmberg, M. J., Hosono, S., Hsieh, M. -J., Hung, K. K. C., Hsu, C. H., Ikeyama, T., Isayama, T., Kapadia, V. S., Kawakami, M. D., Kim, H. -S., Kloeck, D. A., Kudenchuk, P. J., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lockey, A. S., Malta Hansen, C., Markenson, D., Matsuyama, T., Mckinlay, C. J. D., Mehrabian, A., Merchant, R. M., Meyran, D., Morley, P. T., Morrison, L. J., Nation, K. J., Nemeth, M., Neumar, R. W., Nicholson, T., Niermeyer, S., Nikolaou, N., Nishiyama, C., O'Neil, B. J., Orkin, A. M., Osemeke, O., Parr, M. J., Patocka, C., Pellegrino, J. L., Perkins, G. D., Perlman, J. M., Rabi, Y., Reynolds, J. C., Ristagno, G., Roehr, C. C., Sakamoto, T., Sandroni, Claudio, Sawyer, T., Schmolzer, G. M., Schnaubelt, S., Semeraro, F., Skrifvars, M. B., Smith, C. M., Smyth, M. A., Soll, R. F., Sugiura, T., Taylor-Phillips, S., Trevisanuto, D., Vaillancourt, C., Wang, T. -L., Weiner, G. M., Welsford, M., Wigginton, J., Wyllie, J. P., Yeung, J., Nolan, J. P., Berg, K. M., Abelairas-Gomez, C., Barcala-Furelos, R., Beerman, S. B., Bierens, J., Cacciola, Sofia, Cellini, J., Claesson, A., Court, R., D'Arrigo, Sonia, De Brier, N., Dunne, C. L., Elsenga, H. E., Johnson, S., Kleven, G., Maconochie, I., Mecrow, T., Morgan, P., Otto, Q., Palmieri, T. L., Parnia, S., Pawar, R., Pereira, J., Rudd, S., Scapigliati, Andrea, Schmidt, A., Seesink, J., Sempsrott, J. R., Szpilman, D., Warner, D. S., Webber, J. B., West, R. L., Sandroni C. (ORCID:0000-0002-8878-2611), Cacciola S., D'Arrigo S. (ORCID:0000-0001-6740-3195), Scapigliati A. (ORCID:0000-0002-4044-2343), Wyckoff, M. H., Singletary, E. M., Soar, J., Olasveengen, T. M., Greif, R., Liley, H. G., Zideman, D., Bhanji, F., Andersen, L. W., Avis, S. R., Aziz, K., Bendall, J. C., Berry, D. C., Borra, V., Bottiger, B. W., Bradley, R., Bray, J. E., Breckwoldt, J., Carlson, J. N., Cassan, P., Castren, M., Chang, W. -T., Charlton, N. P., Cheng, A., Chung, S. P., Considine, J., Costa-Nobre, D. T., Couper, K., Dainty, K. N., Davis, P. G., de Almeida, M. F., de Caen, A. R., de Paiva, E. F., Deakin, C. D., Djarv, T., Douma, M. J., Drennan, I. R., Duff, J. P., Eastwood, K. J., El-Naggar, W., Epstein, J. L., Escalante, R., Fabres, J. G., Fawke, J., Finn, J. C., Foglia, E. E., Folke, F., Freeman, K., Gilfoyle, E., Goolsby, C. A., Grove, A., Guinsburg, R., Hatanaka, T., Hazinski, M. F., Heriot, G. S., Hirsch, K. G., Holmberg, M. J., Hosono, S., Hsieh, M. -J., Hung, K. K. C., Hsu, C. H., Ikeyama, T., Isayama, T., Kapadia, V. S., Kawakami, M. D., Kim, H. -S., Kloeck, D. A., Kudenchuk, P. J., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lockey, A. S., Malta Hansen, C., Markenson, D., Matsuyama, T., Mckinlay, C. J. D., Mehrabian, A., Merchant, R. M., Meyran, D., Morley, P. T., Morrison, L. J., Nation, K. J., Nemeth, M., Neumar, R. W., Nicholson, T., Niermeyer, S., Nikolaou, N., Nishiyama, C., O'Neil, B. J., Orkin, A. M., Osemeke, O., Parr, M. J., Patocka, C., Pellegrino, J. L., Perkins, G. D., Perlman, J. M., Rabi, Y., Reynolds, J. C., Ristagno, G., Roehr, C. C., Sakamoto, T., Sandroni, Claudio, Sawyer, T., Schmolzer, G. M., Schnaubelt, S., Semeraro, F., Skrifvars, M. B., Smith, C. M., Smyth, M. A., Soll, R. F., Sugiura, T., Taylor-Phillips, S., Trevisanuto, D., Vaillancourt, C., Wang, T. -L., Weiner, G. M., Welsford, M., Wigginton, J., Wyllie, J. P., Yeung, J., Nolan, J. P., Berg, K. M., Abelairas-Gomez, C., Barcala-Furelos, R., Beerman, S. B., Bierens, J., Cacciola, Sofia, Cellini, J., Claesson, A., Court, R., D'Arrigo, Sonia, De Brier, N., Dunne, C. L., Elsenga, H. E., Johnson, S., Kleven, G., Maconochie, I., Mecrow, T., Morgan, P., Otto, Q., Palmieri, T. L., Parnia, S., Pawar, R., Pereira, J., Rudd, S., Scapigliati, Andrea, Schmidt, A., Seesink, J., Sempsrott, J. R., Szpilman, D., Warner, D. S., Webber, J. B., West, R. L., Sandroni C. (ORCID:0000-0002-8878-2611), Cacciola S., D'Arrigo S. (ORCID:0000-0001-6740-3195), and Scapigliati A. (ORCID:0000-0002-4044-2343)

Abstract

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

Published
2021

15. Clinical outcomes from out-of-hospital cardiac arrest in low-resource settings - A scoping review.

Author

Schnaubelt S, Monsieurs KG, Semeraro F, Schlieber J, Cheng A, Bigham BL, Garg R, Finn JC, and Greif R

Subjects
Humans, Patient Discharge, Cardiopulmonary Resuscitation, Emergency Medical Services, Out-of-Hospital Cardiac Arrest therapy
Abstract

Aim of the Scoping Review: Scientific recommendations on resuscitation are typically formulated from the perspective of an ideal resource environment, with little consideration of applicability in lower-income countries. We aimed to determine clinical outcomes from out-of-hospital cardiac arrest (OHCA) in low-resource countries, to identify shortcomings related to resuscitation in these areas and possible solutions, and to suggest future research priorities., Data Sources: This scoping review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We identified low-resource countries as countries with a low- or middle gross national income per capita (World Bank data). We performed a literature search on outcomes after OHCA in these countries, and we extracted data on the outcome. We applied descriptive statistics and conducted a post-hoc correlation analysis of cohort size and ROSC rates., Results: We defined 24 eligible studies originating from middle-income countries, but none from low-income regions, suggesting a reporting bias. The number of reported patients in these studies ranged from 54 to 3214. Utstein-style reporting was rarely used. Return of spontaneous circulation varied from 0% to 62%. Fifteen studies reported on survival to hospital discharge (between 1.0 and 16.7%) or favourable neurological outcome (between 1.0 and 9.3%). An inverse correlation was found for study cohort size and the rate of return of spontaneous circulation (ρ = -0.48, p = 0.034)., Conclusion: Studies of OHCA outcomes in low-resource countries are heterogeneous and may be compromised by reporting bias. Minimum cardiopulmonary resuscitation standards for low-resource settings should be developed collaboratively involving local experts, respecting culture and context while balancing competing health priorities., (Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.)

Published
2020
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16. Pulmonary capillary pressure measurement from pulmonary artery occlusion pressure decay profile analysis in sheep.

Author

Wakerlin GE Jr, Finn JC, Siegel LC, Benson GV, Flavin TF, and Pearl RG

Subjects
15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid, Anesthesia, Inhalation, Animals, Capillaries physiopathology, Cardiac Catheterization, Halothane administration & dosage, Hypertension, Pulmonary physiopathology, Lymph metabolism, Male, Prostaglandin Endoperoxides, Synthetic pharmacology, Pulmonary Edema physiopathology, Reproducibility of Results, Sheep, Thromboxane A2 analogs & derivatives, Thromboxane A2 pharmacology, Vascular Resistance, Vasoconstrictor Agents pharmacology, Catheterization, Pulmonary Artery physiology, Pulmonary Wedge Pressure
Abstract

Pulmonary capillary pressure (Ppc), the major factor responsible for pulmonary edema, cannot be directly measured in intact subjects but may be estimated by analysis of the pressure decay profile after pulmonary artery catheter balloon inflation. We compared three different methods of pulmonary artery occlusion pressure (Ppao) decay profile analysis to estimates of Ppc derived from lymph flow measurements in halothane-anesthesized sheep. The relationship between Ppc and lymph flow was first determined by increasing Ppc by left atrial balloon inflation, and was then used to determine Ppc during pulmonary hypertension produced by infusion of a thromboxane analog. All three methods of Ppao decay profile analysis demonstrated a correlation with Ppc estimated from lymph flow. However, the method using a single exponential analysis significantly overestimated Ppc, and none of the methods reliably estimated changes in the longitudinal distribution of pulmonary vascular resistance during pulmonary hypertension. These results suggest that Ppao decay profile analysis as currently performed has limited application.

Published
1995
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18. Hemodynamic effects of diltiazem during vasoconstrictor pulmonary hypertension in sheep.

Author

Pearl RG and Finn JC

Subjects
Alprostadil therapeutic use, Animals, Hypertension, Pulmonary physiopathology, Male, Nifedipine therapeutic use, Sheep, Diltiazem therapeutic use, Hemodynamics drug effects, Hypertension, Pulmonary drug therapy, Vasodilator Agents therapeutic use
Abstract

Calcium channel blockers have been effective as pulmonary vasodilators in patients with pulmonary hypertension. The current study therefore compared the effects of prostaglandin E1, an effective pulmonary vasodilator, with the effects of the water-soluble calcium channel blocker diltiazem during pulmonary hypertension in sheep. Pulmonary hypertension was produced by continuous intravenous administration of U46619 to halothane-anesthetized sheep. Prostaglandin E1 decreased pulmonary artery pressure 29%, decreased pulmonary vascular resistance (Rp) 57%, and did not affect the ratio of pulmonary to systemic vascular resistance (Rp/Rs). Diltiazem decreased pulmonary artery pressure 15%, decreased Rp 50%, and did not affect Rp/Rs. When 0.33 mL/kg polyethylene glycol-ethanol vehicle (the vehicle used for nifedipine administration in a prior study) was administered during diltiazem infusion, pulmonary artery pressure increased 19%, Rp increased 72%, and Rp/Rs increased 29%. These results indicate that diltiazem is an effective pulmonary vasodilator and suggest that the previously reported unfavorable results of nifedipine may have been due to the vehicle used for nifedipine administration.

Published
1990
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19. A new vascular clamp.

Author

Fogarty TJ, Kinney TB, Finn JC, and Hermann GD

Subjects
Constriction instrumentation, Humans, Surgical Instruments, Vascular Surgical Procedures instrumentation
Abstract

A new vascular clamp called the occluder pad is described. It has significant utility when used in a variety of anatomic sites in either normal or diseased vessels. It possesses suitable tractive and occlusive forces while minimizing the mechanical forces applied to the vessel walls.

Published
1985

20. Current status of dilatation catheters and guiding systems.

Author

Fogarty TJ, Kinney TB, and Finn JC

Subjects
Catheterization instrumentation, Humans, Angioplasty, Balloon instrumentation
Abstract

New transluminal angioplasty catheters based upon the linear extrusion of the dilating element have been developed to facilitate placement of the dilating balloon within the arterial narrowing. In a multicenter study, the use of linear extrusion catheters has been shown to be safe and effective in adjunctive intraoperative peripheral dilatations. Physical measurements of the frictional forces exerted on the inner arterial surfaces during advancement of 3 angioplasty catheter designs show that the linear extrusion catheter consistently minimizes these forces. The use of a secondary guiding sheath in conjunction with a linear extrusion catheter provides additional directional capability. A secondary guiding sheath with a side port has recently been developed that allows access to difficult-to-cannulate vessels. The favorable results of the clinical studies and research data justify an ongoing evaluation of these concepts in percutaneous dilatation procedures and in intraoperative coronary procedures.

Published
1984
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21. Coaxial balloon dilation and calibration of urethral strictures.

Author

Giesy JD, Finn JC, Hermann GD, Kinney TB, and Fogarty TJ

Subjects
Adult, Calibration, Dilatation instrumentation, Dilatation methods, Evaluation Studies as Topic, Female, Humans, Male, Urinary Catheterization methods, Urethral Stricture therapy
Abstract

New coaxial balloon dilators with standard urologic tip configurations have been designed for use in urethral strictures. Balloon dilatation provides several advantages over conventional dilatation of strictures including improved access and decreased mucosal trauma due to a low silhouette, adjustability of diameter and rigidity, decreased instrumentation, and facilitation of intermittent self-dilation by the patient. The instruments were evaluated in 51 strictures (41 patients) as both a dilator and a calibrator. All catheters were located across the stricture easily (although two required filiform attachments). All clinical goals were achieved, and no complications were identified. Two patients were started on a program of intermittent self-dilation after internal urethrotomy with good results. It is our initial clinical impression that slow, gradual dilation of strictures is superior to rapid, abrupt dilation. This can only be practically achieved with balloon dilators.

Published
1984
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22. Shear force in angioplasty: its relation to catheter design and function.

Author

Kinney TB, Fan M, Chin AK, Finn JC, Hayden WG, and Fogarty TJ

Subjects
Equipment Design, Humans, Angioplasty, Balloon instrumentation, Biomechanical Phenomena, Catheterization instrumentation
Abstract

The inability to successfully position angioplasty catheters and the occurrence of complications during angioplasty procedures can, in part, be related to the shear forces generated during catheter introduction. Shear forces are the axial contact forces that the catheter system exerts on the inner arterial surfaces during advancement. The shear forces exerted by three different catheter designs (coaxial dilator, coaxial balloon, and linear extrusion) were measured in normal and atherosclerotic arteries; in modeled stenoses of variable severity, length, and compliance; and in modeled vessel angulations. The results with modeled vessels show that the linear extrusion catheter reduces the level of shear forces, particularly in narrow, long, noncompliant stenoses and in tortuous vessels. The stenotic artery results also show that the linear extrusion catheter minimizes these forces in tight lesions. The relative differences in forces are explained by the mechanism of action for each catheter. The reported occurrences of technical difficulties, complications, and long-term patency rates are then interpreted on the basis of the relative differences in measured shear forces. The results of this study combined with preliminary clinical data indicate that linear extrusion should facilitate placement and reduce associated complications.

Published
1985
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