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In an effort to improve the efficiency of cardiopulmonary resuscitation (CPR), a new inspiratory impedance threshold valve has been developed to enhance the return of blood to the thorax during the chest decompression phase. This new device enhances negative intrathoracic pressure during chest wall recoil or the decompression phase, leading to improved vital organ perfusion during both standard CPR and active compression-decompression CPR. With active compression-decompression CPR, addition of the impedance threshold valve results in sustained diastolic pressures of >55 mm Hg in patients in cardiac arrest. The new valve shows promise for patients in asystole or shock refractory ventricular fibrillation, when enhanced return of blood flow to the chest is needed to “prime the pump.” The potential long-term benefits of this new valve remain under study.