End-Tidal Co 2–Guided Chest Compression Delivery Improves Survival in a Neonatal Asphyxial Cardiac Arrest Model*

Hamrick, Justin; Hamrick, Jennifer L.; Bhalala, Utpal; Armstrong, James C.; Lee, Jeong Hoo; Kulikowicz, Ewa; Lee, Jennifer K.; Kudchadkar, Sapna R.; Koehler, Raymond C.; Hunt, Elizabeth A.; Shaffner, Donald H.

doi:10.1097/pcc.0000000000001299

Cited by 45 publications

(44 citation statements)

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“…We conducted a retrospective, secondary analysis of data from piglet cardiac arrest studies that we published previously as well as unpublished studies. All studies were approved by the Animal Care and Use Committee at the Johns Hopkins University.…”

Section: Methodsmentioning

confidence: 99%

“…All studies were approved by the Animal Care and Use Committee at the Johns Hopkins University. The protocols have been described previously . In brief, 1‐2‐week‐old, male Yorkshire swine (3‐4 kg) were anesthetized with 2% isoflurane, 70% nitrous oxide, and 30% oxygen.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…We report the results from 154 animal experiments in three studies, 28 were reported in a 20‐minute asphyxia model, 56 were reported in a 17‐minute and 23‐minute asphyxia comparison, and 70 are included in an unpublished comparison of five asphyxia durations. Our piglet cardiac arrest studies were originally designed to compare two CPR techniques . In all studies, we produced an asphyxia or asphyxial‐fibrillatory arrest of 11 to 23 minutes (varied by protocol) by clamping the endotracheal tube and, when combined with fibrillation, by applying electrical current to a right ventricular transvenous pacing wire.…”

Section: Methodsmentioning

confidence: 99%

“…We have extensive experience with a swine model of pediatric asphyxial arrest and the use of pressure‐controlled ventilation during CPR . In those studies, we found that by modifying CPR efforts to maximize end‐tidal carbon dioxide (ETCO 2 ) values after a 20‐minute asphyxia and fibrillation arrest, the rate of ROSC was superior to standard CPR (50% vs 14%, P = .04) .…”

Section: Introductionmentioning

confidence: 99%

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The use of pressure‐controlled mechanical ventilation in a swine model of intraoperative pediatric cardiac arrest

Lapid

O’Brien

Kudchadkar

et al. 2020

Pediatric Anesthesia

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Background: Current pediatric resuscitation guidelines suggest that resuscitators using an advanced airway deliver 8-10 breaths per minute while carefully avoiding excessive ventilation. In the intraoperative setting, having a dedicated ventilation rescuer may be difficult because of limited personnel. Continuing pressure-controlled mechanical ventilation during resuscitation for intraoperative cardiac arrest reduces personnel needed and the risk of hyperventilation but might risk hypoventilation during chest compression delivery. Aims:To determine whether the use of pressure-controlled mechanical ventilation at prearrest settings provides normoxia and normocarbia during resuscitation from cardiac arrest. Methods:We retrospectively analyzed combined data from preclinical randomized controlled trials. Two-week-old swine (3-4 kg) underwent asphyxia-induced cardiac arrest. Animals were resuscitated with periods of basic and advanced life support.During resuscitation, pressure-controlled mechanical ventilation was delivered at the prearrest respiratory rate, peak inspiratory pressure, and positive end-expiratory pressure. Arterial blood gases were measured prearrest, at 11 minutes of asphyxia, and at 8 and 20 minutes of cardiopulmonary resuscitation.Results: Piglets (n = 154) received pressure-controlled mechanical ventilation before and during cardiopulmonary resuscitation with a peak inspiratory pressure of 14-15 cm H 2 O, positive end-expiratory pressure of 4 cm H 2 O, 20 breaths/minute, and an inspiratory:expiratory ratio of 1:2. During asphyxia, the arterial blood gas showed the expected severe hypercarbia and hypoxia. Continuing pressure-controlled mechanical ventilation using prearrest parameters and increasing the FiO 2 to 1.0 returned the PaCO 2 to prearrest levels and slightly increased the partial pressure of arterial oxygen at 8 and 20 minutes of cardiopulmonary resuscitation. Conclusion:In this piglet model of resuscitation from asphyxial arrest, pressure-controlled mechanical ventilation during cardiopulmonary resuscitation at the prearrest ventilator settings with an FiO 2 of 1.0 provides adequate oxygenation and restores normocarbia. Clinical investigation is warranted to determine the benefits of continuing pressure-controlled mechanical ventilation at prearrest parameters during pediatric cardiopulmonary resuscitation. How to cite this article: Lapid FM, O'Brien CE, Kudchadkar SR, et al. The use of pressure-controlled mechanical ventilation in a swine model of intraoperative pediatric cardiac arrest. Pediatr

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The use of pressure‐controlled mechanical ventilation in a swine model of intraoperative pediatric cardiac arrest

Lapid

O’Brien

Kudchadkar

et al. 2020

Pediatric Anesthesia

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Effect of Physiologic Point-of-Care Cardiopulmonary Resuscitation Training on Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs

Sutton

Wolfe

Reeder

et al. 2022

JAMA

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IMPORTANCE Approximately 40% of children who experience an in-hospital cardiac arrest survive to hospital discharge. Achieving threshold intra-arrest diastolic blood pressure (BP) targets during cardiopulmonary resuscitation (CPR) and systolic BP targets after the return of circulation may be associated with improved outcomes. OBJECTIVE To evaluate the effectiveness of a bundled intervention comprising physiologically focused CPR training at the point of care and structured clinical event debriefings. DESIGN, SETTING, AND PARTICIPANTSA parallel, hybrid stepped-wedge, cluster randomized trial (Improving Outcomes from Pediatric Cardiac Arrest-the ICU-Resuscitation Project [ICU-RESUS]) involving 18 pediatric intensive care units (ICUs) from 10 clinical sites in the US. In this hybrid trial, 2 clinical sites were randomized to remain in the intervention group and 2 in the control group for the duration of the study, and 6 were randomized to transition from the control condition to the intervention in a stepped-wedge fashion. The index (first) CPR events of 1129 pediatric ICU patients were included between October 1, 2016, and March 31, 2021, and were followed up to hospital discharge (final follow-up was April 30, 2021).INTERVENTION During the intervention period (n = 526 patients), a 2-part ICU resuscitation quality improvement bundle was implemented, consisting of CPR training at the point of care on a manikin (48 trainings/unit per month) and structured physiologically focused debriefings of cardiac arrest events (1 debriefing/unit per month). The control period (n = 548 patients) consisted of usual pediatric ICU management of cardiac arrest. MAIN OUTCOMES AND MEASURESThe primary outcome was survival to hospital discharge with a favorable neurologic outcome defined as a Pediatric Cerebral Performance Category score of 1 to 3 or no change from baseline (score range, 1 [normal] to 6 [brain death or death]). The secondary outcome was survival to hospital discharge. RESULTS Among 1389 cardiac arrests experienced by 1276 patients, 1129 index CPR events (median patient age, 0.6 [IQR, 0.2-3.8] years; 499 girls [44%]) were included and 1074 were analyzed in the primary analysis. There was no significant difference in the primary outcome of survival to hospital discharge with favorable neurologic outcomes in the intervention group (53.8%) vs control (52.4%); risk difference (RD), 3.2% (95% CI, −4.6% to 11.4%); adjusted OR, 1.08 (95% CI, 0.76 to 1.53). There was also no significant difference in survival to hospital discharge in the intervention group (58.0%) vs control group (56.8%); RD, 1.6% (95% CI, −6.2% to 9.7%); adjusted OR, 1.03 (95% CI, 0.73 to 1.47). CONCLUSIONS AND RELEVANCEIn this randomized clinical trial conducted in 18 pediatric intensive care units, a bundled intervention of cardiopulmonary resuscitation training at the point of care and physiologically focused structured debriefing, compared with usual care, did not significantly improve patient survival to hospital discharge with favorable neurologic outco...

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Pediatric In-Hospital Cardiac Arrest and Cardiopulmonary Resuscitation in the United States

et al. 2021

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n estimated 15 200 children receive cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest (IHCA) annually in the United States. 1 Pediatric IHCA outcomes improved during the first decade of the 21st century, 2,3 likely owing to a widespread recognition of the need for high-quality resuscitation and a focus on recognizing and transferring the deteriorating pediatric inpatient to an intensive care unit (ICU). However, survival rates have plateaued and more than half of children with IHCA do not survive to hospital discharge. 3 Compared with adults with IHCA, children with IHCA differ in demographic characteristics, location within the hospital, cause of cardiac arrest, initial cardiac arrest rhythm, and type of monitoring in place. [4][5][6][7] Table 1 shows a comparison of these variables between pediatric and adult patients. 3-8 However, prospective pediatric IHCA studies are limited, and most pediatric resuscitation guidelines are extrapolated from adult guidelines. 9,10 Substantial differences also exist between pediatric IHCA and pediatric out-of-hospital cardiac arrest (OHCA). Although IHCA occurrence is frequently associated with the progression of underlying disease processes, such as shock and respiratory failure, common causes of pediatric OHCA include drowning, sudden infant death syndrome, and sudden cardiac death from arrhythmias. 11 Compared with IHCA, OHCA survival outcomes are worse, 12 and OHCA systems of care are focused on encouraging bystander CPR and optimizing basic life support measures in the prehospital state. 13 Pediatric IHCA is a modifiable disease process. Efforts to prevent its occurrence, treat it with high-quality CPR, and deliver successful post-cardiac arrest care can demonstrably improve outcomes. In this narrative review, we discuss pediatric IHCA, including incidence, causes, prevention, treatment, and post-cardiac arrest therapies. MethodsThis narrative review was based on several informal searches of PubMed for peer-reviewed English-language articles related to pediatric IHCA. The searches were conducted between January 4, IMPORTANCE Pediatric in-hospital cardiac arrest (IHCA) occurs frequently and is associated with high morbidity and mortality. The objective of this narrative review is to summarize the current knowledge and recommendations regarding pediatric IHCA and cardiopulmonary resuscitation (CPR).OBSERVATIONS Each year, more than 15 000 children receive CPR for cardiac arrest during hospitalization in the United States. As many as 80% to 90% survive the event, but most patients do not survive to hospital discharge. Most IHCAs occur in intensive care units and other monitored settings and are associated with respiratory failure or shock. Bradycardia with poor perfusion is the initial rhythm in half of CPR events, and only about 10% of events have an initial shockable rhythm. Pre-cardiac arrest systems focus on identifying at-risk patients and ensuring that they are in monitored settings. Important components of CPR include high-quality chest compressio...

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End-Tidal Co 2–Guided Chest Compression Delivery Improves Survival in a Neonatal Asphyxial Cardiac Arrest Model*

Cited by 45 publications

References 45 publications

The use of pressure‐controlled mechanical ventilation in a swine model of intraoperative pediatric cardiac arrest

The use of pressure‐controlled mechanical ventilation in a swine model of intraoperative pediatric cardiac arrest

Effect of Physiologic Point-of-Care Cardiopulmonary Resuscitation Training on Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs

Pediatric In-Hospital Cardiac Arrest and Cardiopulmonary Resuscitation in the United States

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