b-card symposium
From the Idea to the Product
b-card Concept & Functionalities
Tuesday
March 7th
2017
Georges BOUSSIGNAC, ...
Introduction
to the b-card
Concept
©	B.	Garrigue,	RN
ILCOR Cardiac Arrest Ventilation
Unresponsive	patient
Abnormal	respiration
Call	
Emergency	
Services
CPR	30:2
Set	up	Defibrilator
Minimize	interruptions
Ch...
Q
Why Optimizing
Chest Compressions?
Optimize chest compressions
⇧ length compressions
⇧ depth of compressions
Increase cerebral and coronary
perfusion
⇧ ROSC ...
Unresponsive	patient
Abnormal	respiration
Call	
Emergency	
Services
CPR	30:2
Set	up	Defibrilator
Minimize	interruptions
Ch...
EtCO2
ILCOR
2015
O2
Correct oxygenation of the patient -> Efficacy of oxygenation
Control the quality of ventilation -> Ca...
Can We Do Both
(Ventilation and Oxygenation)
Correctly and at the Same Time?
Q
ILCOR
2015
CPR
30:2
Continuous
Ventilation
10-12/min
ILCOR
2015
The goal is to ventilate and
oxygenate the patient by minimizing
chest compressions interruptions
without damag...
What Is the Current Practice of
Ventilation Techniques in the Field?
Q
Prolonged interruptions in chest compressions, for
reasons other than defibrillation, worsen clinical
outcomes for out-of-...
Real	CPRIdeal	CPR
30 30 30 30
2 2 2
30 30 30
2
2
2
30	Chest	
compressions															
2	insufflations	
10s
20s
« Most o...
Interrupt chest
compressions for ventilation
may damage
heamodynamics during CPR
(coronary perfusion pressure
falls)
Data ...
Is There A Scientific Rational?
Q
Ventilation	
during chest
compressions	
triggers	
asynchronisms
Decrease	of	venous	return
Positive	pressure	at	decompressi...
What Is Your Solution?
Q
The Concept
of b-card
Dr	Georges
Boussignac
• The AV-CCC	concept	improves	
hemodynamics	and	ventilation
Ø Gas flow rate at 15L/min
Ø Turbulences (virtual valve)
creat...
BREATHING
OUTCOMPRESSION
BREATHING
INRELAXATION
Expiratory Resistance
During Chest
Compression
Optimised energy
transmission from
chest compressions
to the circulatory
sy...
Inspiratory Resistance
During Chest
Decompression
Negative
Intrathoracic
Pressure
Venous return
Increased pre-load
and cor...
b-card Maintains BP
Hands = Ventilator
Did You Test the b-card?
Q
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	Pap...
R
e
s
u
l
t
s
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 ...
80,0
0
20
40
60
80
100
not aged Aged 3 years according
to C2134
Pressure limitation under single fault condition
1:obstruc...
80,0
0
20
40
60
80
100
not aged Aged 3 years
according to C2134
Pressure limitation under single fault
condition n°2: inap...
-This report proves that b-card creates a positive intra-thoracic pressure at compression and a negative intra-
thoracic p...
How To Use It?
Q
With a
Mask
With a
Supraglottic
Device
With an
ET Tube
Use of b-card
Continuous Chest Compressions + b-card
April 2016: Evreux General Hospital
Cardiac Arrest 70-year-old Male
CPR with b-card...
40
Conclusion
No Pause Should Be Your Cause
b-card symposium
Thank You for Your Attention
Q & A
Tuesday
March 7th
2017
Georges BOUSSIGNAC, MD & Nicolas PESCHANSKI, MD...
RCP Alveoli Ventilation with Continuous Chest Compression - b-card concept & functionalities
RCP Alveoli Ventilation with Continuous Chest Compression - b-card concept & functionalities
RCP Alveoli Ventilation with Continuous Chest Compression - b-card concept & functionalities
RCP Alveoli Ventilation with Continuous Chest Compression - b-card concept & functionalities
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RCP Alveoli Ventilation with Continuous Chest Compression - b-card concept & functionalities

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

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RCP Alveoli Ventilation with Continuous Chest Compression - b-card concept & functionalities

  1. 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. 2. Introduction to the b-card Concept © B. Garrigue, RN
  3. 3. ILCOR Cardiac Arrest Ventilation
  4. 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. 5. Q Why Optimizing Chest Compressions?
  6. 6. Optimize chest compressions ⇧ length compressions ⇧ depth of compressions Increase cerebral and coronary perfusion ⇧ ROSC rate Dr Georges Boussignac
  7. 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. 8. EtCO2 ILCOR 2015 O2 Correct oxygenation of the patient -> Efficacy of oxygenation Control the quality of ventilation -> Capnography – EtC02 Recommendations
  9. 9. Can We Do Both (Ventilation and Oxygenation) Correctly and at the Same Time? Q
  10. 10. ILCOR 2015 CPR 30:2 Continuous Ventilation 10-12/min
  11. 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. 12. What Is the Current Practice of Ventilation Techniques in the Field? Q
  13. 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. 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. 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. 16. Is There A Scientific Rational? Q
  17. 17. Ventilation during chest compressions triggers asynchronisms Decrease of venous return Positive pressure at decompression Dr Georges Boussignac
  18. 18. What Is Your Solution? Q
  19. 19. The Concept of b-card Dr Georges Boussignac
  20. 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
  21. 21. BREATHING OUTCOMPRESSION BREATHING INRELAXATION
  22. 22. Expiratory Resistance During Chest Compression Optimised energy transmission from chest compressions to the circulatory system Increased Intrathoracic Pressure Improved Heamodynamics
  23. 23. Inspiratory Resistance During Chest Decompression Negative Intrathoracic Pressure Venous return Increased pre-load and coronary perfusion Increased cardiac output
  24. 24. b-card Maintains BP
  25. 25. Hands = Ventilator
  26. 26. Did You Test the b-card? Q
  27. 27. 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
  28. 28. R e s u l t s
  29. 29. 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
  30. 30. 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
  31. 31. 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
  32. 32. -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
  33. 33. How To Use It? Q
  34. 34. With a Mask With a Supraglottic Device With an ET Tube Use of b-card
  35. 35. 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
  36. 36. 40 Conclusion No Pause Should Be Your Cause
  37. 37. b-card symposium Thank You for Your Attention Q & A Tuesday March 7th 2017 Georges BOUSSIGNAC, MD & Nicolas PESCHANSKI, MD, PhD

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