Continuous chest compressions with asynchronous ventilations increase carotid blood flow in the perinatal asphyxiated lamb model.
Pediatr Res
; 90(4): 752-758, 2021 10.
Article
en En
| MEDLINE
| ID: mdl-33469187
ABSTRACT
BACKGROUND:
The neonatal resuscitation program (NRP) recommends interrupted chest compressions (CCs) with ventilation in the severely bradycardic neonate. The conventional 31 compression-to-ventilation (CV) resuscitation provides 90 CCs/min, significantly lower than the intrinsic newborn heart rate (120-160 beats/min). Continuous CC with asynchronous ventilation (CCCaV) may improve the success of return of spontaneous circulation (ROSC).METHODS:
Twenty-two near-term fetal lambs were randomized to interrupted 31 CV (90 CCs + 30 breaths/min) or CCCaV (120 CCs + 30 breaths/min). Asphyxiation was induced by cord occlusion. After 5 min of asystole, resuscitation began following NRP guidelines. The first dose of epinephrine was given at 6 min. Invasive arterial blood pressure and left carotid blood flow were continuously measured. Serial arterial blood gases were collected.RESULTS:
Baseline characteristics between groups were similar. Rate of and time to ROSC was similar between groups. CCCaV was associated with a higher PaO2 (partial oxygen tension) (22 ± 5.3 vs. 15 ± 3.5 mmHg, p < 0.01), greater left carotid blood flow (7.5 ± 3.1 vs. 4.3 ± 2.6 mL/kg/min, p < 0.01) and oxygen delivery (0.40 ± 0.15 vs. 0.13 ± 0.07 mL O2/kg/min, p < 0.01) compared to 31 CV.CONCLUSIONS:
In a perinatal asphyxiated cardiac arrest lamb model, CCCaV showed greater carotid blood flow and cerebral oxygen delivery compared to 31 CV resuscitation. IMPACT In a perinatal asphyxiated cardiac arrest lamb model, CCCaV improved carotid blood flow and oxygen delivery to the brain compared to the conventional 31 CV resuscitation. Pre-clinical studies assessing neurodevelopmental outcomes and tissue injury comparing continuous uninterrupted chest compressions to the current recommended 31 CV during newborn resuscitation are warranted prior to clinical trials.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Asfixia Neonatal
/
Flujo Sanguíneo Regional
/
Respiración Artificial
/
Arterias Carótidas
/
Reanimación Cardiopulmonar
Tipo de estudio:
Clinical_trials
/
Guideline
/
Prognostic_studies
Límite:
Animals
/
Humans
/
Newborn
Idioma:
En
Revista:
Pediatr Res
Año:
2021
Tipo del documento:
Article
País de afiliación:
Estados Unidos