Effect of Different Respiratory Modes on Return of Spontaneous Circulation in a Newborn Piglet Model of Hypoxic Cardiac Arrest

Mendler, Marc Robin; Weber, Claudia; Hassan, Mohammad Ahmad; Huang, Li; Waitz, Markus; Mayer, Benjamin; Hummler, Helmut

doi:10.1159/000439020

Cited by 16 publications

(27 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is potentially similar to delivery room resuscitations, which includes vascular shunting via the ductus arteriosus. Other research groups reported higher percentages in ROSC [29,30,31,32]. These studies have different surgical protocols which may explain the differences in percentages of survivors.…”

Section: Discussionmentioning

confidence: 89%

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Görens²,

Cheung³

et al. 2017

Neonatology

View full text Add to dashboard Cite

Background: Recently, sustained inflations (SI) during chest compression (CC) (CC+SI) have been suggested as an alternative to the current approach during neonatal resuscitation. No previous study compared CC+SI using CC rates of 90/min to the current 3:1 compression:ventilation ratio (C:V). Objective: To determine whether CC+SI versus a 3:1 C:V reduces the time to the return of spontaneous circulation (ROSC) and improves hemodynamic recovery in newborn piglets with asphyxia-induced bradycardia. Intervention and Measurements: Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-min normocapnic hypoxia followed by asphyxia. Cardiopulmonary resuscitation (CPR) was initiated when the heart rate decreased to 25% of baseline. Piglets were randomized into 3 groups: CC during SI at a rate of 90 CC/min (SI+CC 90, n = 8), a 3:1 C:V using 90 CC and 30 inflations (3:1, n = 8), or a sham group (n = 6). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. Results: CC+SI significantly reduced the median (IQR) time of ROSC, i.e., 34 s (28-156 s) versus 210 s (72-300 s) in the 3:1 group (p = 0.048). CC+SI also significantly reduced the requirement for 100% oxygen, improved respiratory parameters, and resulted in a similar hemodynamic recovery. Conclusions: CC+SI during CPR significantly improved ROSC in a porcine model of neonatal resuscitation. This is of considerable clinical relevance because improved respiratory and hemodynamic parameters potentially minimize morbidity and mortality in newborn infants.

show abstract

Section: Discussionmentioning

confidence: 89%

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Görens²,

Cheung³

et al. 2017

Neonatology

View full text Add to dashboard Cite

show abstract

“…ROSC, in our model, was defined as a heart rate >60 beats/min together with return of spontaneous pulsatility in the arterial blood pressure waveform. The animals were randomized for 3 different types of respiratory support and the results of this analysis, including duration of resuscitative efforts and epinephrine use, were published elsewhere [14]. However, for the purpose of this study all animals were analyzed as one group.…”

Section: Methodsmentioning

confidence: 99%

Reliability of Pulse Oximetry during Progressive Hypoxia, Cardiopulmonary Resuscitation, and Recovery in a Piglet Model of Neonatal Hypoxic Cardiac Arrest

et al. 2017

Self Cite

View full text Add to dashboard Cite

Background: Pulse oximetry is widely used in intensive care and emergency conditions to monitor arterial oxygenation and to guide oxygen therapy. Objective: To study the reliability of pulse oximetry in comparison with CO-oximetry in newborn piglets during progressive hypoxia, cardiac arrest, cardiopulmonary resuscitation (CPR), and after return of spontaneous circulation (ROSC). Methods: Thirty-three newborn piglets were exposed to hypoxia until asystole occurred and then resuscitated until ROSC. Arterial oxygen saturation was monitored continuously by pulse oximetry (SpO₂) with one sensor applied to the wrist of the right forelimb (FL) and another to the thigh of the left hind limb (HL). Arterial functional oxygen saturation (SaO₂) was measured at baseline and at predefined intervals during each phase of the experiment. SpO₂ was compared with coinciding SaO₂ values and bias considered whenever the difference (SpO₂ - SaO₂) was beyond ±5%. Results: Bias values were lower at the baseline measurements (-3.7 ± 2.3% in FL and -4.1 ± 3.4% in HL) as well as after ROSC (1.5 ± 4.2% in FL and 0.2 ± 4.6% in HL) with higher precision and accuracy than during other experiment phases. During hypoxia induction, cardiac arrest, and CPR, there was a marked decrease in precision and accuracy as well as an increase in bias up to 43 ± 26 and 56 ± 27% in FL and HL, respectively, over a range of SaO₂ from 13 to 51%. Conclusion: Pulse oximetry showed increased bias and decreased accuracy and precision during marked hypoxemia in a model of neonatal hypoxic cardiac arrest.

show abstract

“…Due to the design of the various devices and depending on the user's experience, differences in the accuracy of applied parameters (airway pressure, PEEP, tidal volume, inspiratory time) are expected [11,12,13,14]. In a previously published experiment we did not find significant effects of 3 different devices for respiratory support during CPR on the return of spontaneous circulation [7]. In this detailed analysis of respiratory parameters, we found differences in delivered tidal volumes and leak and observed interaction between inflations and cardiac compressions.…”

Section: Discussionmentioning

confidence: 99%

“…All 33 newborn piglets were studied after immediate neonatal transition and were included in this analysis. A detailed description on instrumentation/procedures (including a sample size calculation) is available in the original publication [7]. Briefly, animals were anesthetized and intubated with weight-adapted uncuffed ET and instrumented.…”

Section: Methodsmentioning

confidence: 99%

Tidal Volume Delivery and Endotracheal Tube Leak during Cardiopulmonary Resuscitation in Intubated Newborn Piglets with Hypoxic Cardiac Arrest Exposed to Different Modes of Ventilatory Support

Mendler

Weber²,

Hassan³

et al. 2016

Neonatology

Self Cite

View full text Add to dashboard Cite

Background: There are few data available on the interaction of inflations, chest compressions (CC), and delivery of tidal volumes in newborn infants undergoing resuscitation in the presence of endotracheal tube (ET) leaks. Objectives: To determine the effects of different respiratory support strategies along with CC on changes in tidal volume and ET leaks in hypoxic newborn piglets with cardiac arrest. Methods: Asphyxiated newborn piglets, intubated with weight-adapted uncuffed ET, were randomized into three groups and resuscitated according to ILCOR 2010 guidelines: (1) T-piece resuscitator (TPR) group = peak inspiratory pressure (PIP)/positive end-expiratory pressure (PEEP) 25/5 cm H₂O, rate 30/min, inflations interposed between CC (3:1 ratio); (2) self- inflating bag (SIB) group = PIP 25 cm H₂O without PEEP, rate 30/min, inflations interposed between CC (3:1 ratio), and (3) ventilator group = PIP/PEEP of 25/5 cm H₂O, rate 30/min. CC were applied with a rate of 120/min without synchrony to inflations. Results: We observed a significant increase of leak (average increase 11.4%) when CC was added to respiratory support (p = 0.0001). Expired tidal volume was larger in the SIB group than in the two other modes which both applied PEEP. However, tidal volumes caused by CC only were larger in the two groups with PEEP than in the SIB group (without PEEP). Conclusions: There is interaction between lung inflations and CC affecting leak and delivery of tidal volume, which may be influenced by the mode/device used for respiratory support. Leak is larger in the presence of PEEP. However, CC cause additional tidal volume which is larger in the presence of PEEP.

show abstract

Effect of Different Respiratory Modes on Return of Spontaneous Circulation in a Newborn Piglet Model of Hypoxic Cardiac Arrest

Cited by 16 publications

References 26 publications

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Reliability of Pulse Oximetry during Progressive Hypoxia, Cardiopulmonary Resuscitation, and Recovery in a Piglet Model of Neonatal Hypoxic Cardiac Arrest

Tidal Volume Delivery and Endotracheal Tube Leak during Cardiopulmonary Resuscitation in Intubated Newborn Piglets with Hypoxic Cardiac Arrest Exposed to Different Modes of Ventilatory Support

Contact Info

Product

Resources

About