From the concept to the field: b-card RCP-Ventilation A Live Presentation Interview of Georges Boussignac, MD about his invention

1. b-card symposium
From the Idea to the Product
b-card Concept & Functionalities
Tuesday
March 7th
2017
Georges BOUSSIGNAC, MD & Nicolas PESCHANSKI, MD, PhD

2. Introduction
to the b-card
Concept
© B. Garrigue, RN

3. ILCOR Cardiac Arrest Ventilation

4. Unresponsive patient
Abnormal respiration
Call
Emergency
Services
CPR 30:2
Set up Defibrilator
Minimize interruptions
Choc
Minimize
interreptions
CPR immediately
after 2 minutes
Minimize
interreptions
CPR
immediately
after 2 minutes
Minimize
interruptions
Post-
Ressuscitation
treatment
SaO2 > 94-98%
Normal PaCO2
ECG 12 lead
Treat the origin of
cardiac arrest
origin
Terapeutic
hypothermia
Unchocable Rhythm
Asystole/PEA
Chocable
Rhythm
FV -TV
ROSC
Evaluate the Rhythm
ILCOR
2015
Optimizing Chest Compressions

5. Q
Why Optimizing
Chest Compressions?

6. Optimize chest compressions
⇧ length compressions
⇧ depth of compressions
Increase cerebral and coronary
perfusion
⇧ ROSC rate
Dr Georges
Boussignac

7. Unresponsive patient
Abnormal respiration
Call
Emergency
Services
CPR 30:2
Set up Defibrilator
Minimize interruptions
Choc
Minimize
interreptions
CPR immediately
after 2 minutes
Minimize
interreptions
CPR
immediately
after 2 minutes
Minimize
interruptions
Post-Ressuscitation
treatment
SaO2 > 94-98%
Normal PaCO2
ECG 12 lead
Treat the origin of
cardiac arrest origin
Terapeutic
hypothermia
Unchocable Rhythm
Asystole/PEA
Chocable
Rhythm
FV -TV
ROSC
Evaluate the rhythm
ILCOR
2015
Oxygenation ?

8. EtCO2
ILCOR
2015
O2
Correct oxygenation of the patient -> Efficacy of oxygenation
Control the quality of ventilation -> Capnography – EtC02
Recommendations

9. Can We Do Both
(Ventilation and Oxygenation)
Correctly and at the Same Time?
Q

10. ILCOR
2015
CPR
30:2
Continuous
Ventilation
10-12/min

11. ILCOR
2015
The goal is to ventilate and
oxygenate the patient by minimizing
chest compressions interruptions
without damaging hemodynamics
Ventilation Is Still A Stake

12. What Is the Current Practice of
Ventilation Techniques in the Field?
Q

13. Prolonged interruptions in chest compressions, for
reasons other than defibrillation, worsen clinical
outcomes for out-of-hospital cardiac arrest
patients with ventricular fibrillation
13
Brouwer T, Walker R, Chapman F, Koster, R.
Association Between Chest Compression Interruptions and
Clinical Outcomes of Ventricular Fibrillation
Out-of-Hospital Cardiac Arrest. Circulation. 2015;132:1030-1037.
Dr Georges
Boussignac

14. Real CPRIdeal CPR
30 30 30 30
2 2 2
30 30 30
2
2
2
30 Chest
compressions
2 insufflations
10s
20s
« Most of the time, interruption in chest compressions is too
long (20 secs) and chest compressions are not delivered
Berg, et al. Circulation 2001
Manual ventilation in the field todayDr Georges
Boussignac

15. Interrupt chest
compressions for ventilation
may damage
heamodynamics during CPR
(coronary perfusion pressure
falls)
Data Analysis
Continuous variables such as blood pressures, CPP, iCPP, and blood
gas analyses were evaluated by 2-tailed, unpaired Student’s t test and
described as meanϮSEM. Continuous variables that were not nor-
mally distributed (myocardial blood flows, cardiac outputs, and
oxygen deliveries) were evaluated by Mann-Whitney U test and
described as median (25%, 75%). In the CCϩRB group, we
demonstrable independently at
of CPR (Figure 2).
Thirteen of the 14 animals
neurological outcome. Six of
7 CCϩRB animals were in ce
at 24 hours (ie, normal); 1 i
Figure 1. Aortic (A
(RA, light band) pr
CCϩRB, with a 15
Aortic relaxation, o
der of dark band)
breaths, resulting
compressions of n
or diastolic, pressu
ference between A
is CPP.
Berg et al Adverse Effects of Rescue BreatSide effects
Berg, et al. Circulation 2001
Dr Georges
Boussignac
Consequences on Hemodynamics

16. Is There A Scientific Rational?
Q

17. Ventilation
during chest
compressions
triggers
asynchronisms
Decrease of venous return
Positive pressure at decompression
Dr Georges
Boussignac

18. What Is Your Solution?
Q

19. The Concept
of b-card
Dr Georges
Boussignac

20. • The AV-CCC concept improves
hemodynamics and ventilation
Ø Gas flow rate at 15L/min
Ø Turbulences (virtual valve)
created in b-card
Ø Control the exit and entry of gas
from the respiratory tract and
lungs
Ø Creation of static lung pressure
of 5 to 8 cmH2O

22. BREATHING
OUTCOMPRESSION
BREATHING
INRELAXATION

23. Expiratory Resistance
During Chest
Compression
Optimised energy
transmission from
chest compressions
to the circulatory
system
Increased
Intrathoracic
Pressure
Improved
Heamodynamics

24. Inspiratory Resistance
During Chest
Decompression
Negative
Intrathoracic
Pressure
Venous return
Increased pre-load
and coronary
perfusion
Increased cardiac
output

28. b-card Maintains BP

29. Hands = Ventilator

30. Did You Test the b-card?
Q

31. ml
a
b
c
d
e f
a. Ressort
b. Soufflet
c. Seringue
d. Prise de pression
dans le soufflet
e. Entré d’air
f. Stylet et Papier
millimétrique
f
Pressure transmitted to the
thoracic space
Change in lung volume: Vt and FRC
Impact of different ventilation strategies during chest compression. An experimental and
clinical study. RL Cordioli,A Lyazidi,N Rey,, JM Grannier, D Savary, L Brochard , JC M Richard.
Bench Tests

32. R
e
s
u
l
t
s

33. 60,0
0
20
40
60
80
100
not aged Aged 3 years
according to C2134
Pressure limitation under normal use (cmH2O)
Based on the samples tested, the higher end value of the statistical
interval is 13.4 cmH2O compared to an acceptance criterion of
maximum 60.0 cmH2O
R
e
s
u
l
t
s

34. 80,0
0
20
40
60
80
100
not aged Aged 3 years according
to C2134
Pressure limitation under single fault condition
1:obstruction of the open system (cmH2O)
Based on the samples tested, the higher end value of the statistical
interval is 41.4 cmH2O compared to an acceptance criterion of
maximum 80.0 cmH2O.
R
e
s
u
l
t
s

35. 80,0
0
20
40
60
80
100
not aged Aged 3 years
according to C2134
Pressure limitation under single fault
condition n°2: inappropriate flow rate setting
(cmH2O)
Based on the samples tested, the higher end value of the statistical interval is
42.4 cmH2O compared to an acceptance criterion of maximum 80.0 cmH2O.
R
e
s
u
l
t
s

36. -This report proves that b-card creates a positive intra-thoracic pressure at compression and a negative intra-
thoracic pressure at decompression which helps improve the venous return and hemodynamics to the whole body.
- Secondly, the tidal volume delivered is improved compare to Intermittent Positive PressureVentilation with Bag-
Valve Mask (BVM). Indeed, the volume delivered at decompression is minimum 315 ml and maximum 369 ml.
Summary
R
e
s
u
l
t
s

37. How To Use It?
Q

38. With a
Mask
With a
Supraglottic
Device
With an
ET Tube
Use of b-card

39. Continuous Chest Compressions + b-card
April 2016: Evreux General Hospital
Cardiac Arrest 70-year-old Male
CPR with b-card: SpO2 at 80 % then 90%.
b-card in Action
© A. Depil-Duval, MD

40. 40
Conclusion
No Pause Should Be Your Cause

41. b-card symposium
Thank You for Your Attention
Q & A
Tuesday
March 7th
2017
Georges BOUSSIGNAC, MD & Nicolas PESCHANSKI, MD, PhD