Improved blood flow during prolonged cardiopulmonary resuscitation with 30% duty cycle in infant pigs.

Dean, Janet; Koehler, Raymond C.; Schleien, Charles L.; Atchison, Deborah J.; Gervais, H.; Berkowitz, Ivor; Traystman, Richard J.

doi:10.1161/01.cir.84.2.896

Cited by 66 publications

(26 citation statements)

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“…A further study in piglets suggested that sustained chest compressions had a deleterious effect on myocardial and cerebral perfusion, especially during prolonged resuscitation. 76 A physiologic mathematical modeling study suggested that using higher compression-ventilation ratios would result in underventilation of asphyxiated infants (LOE 5 77 ). The model predicts that between 3 and 5 compressions to 1 ventilation should be most efficient for newborns.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 11: Neonatal Resuscitation

Perlman¹,

Wyllie²,

Kattwinkel³

et al. 2010

Circulation

563

358

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Section: Consensus On Sciencementioning

confidence: 99%

Part 11: Neonatal Resuscitation

Perlman¹,

Wyllie²,

Kattwinkel³

et al. 2010

Circulation

563

358

View full text Add to dashboard Cite

“…Consequently, the evidence base for these interventions during neonatal resuscitation remains low, and data is extrapolated largely from adult or animal resuscitation studies (1,7,8). However, most animal studies have been conducted in adult models (10,11) or newborn animals (12)(13)(14) that were hours or days into postnatal life. Therefore, most of the information from these studies is of limited applicability to neonatal delivery room resuscitation.…”

mentioning

confidence: 99%

Effects of chest compressions on cardiovascular and cerebral hemodynamics in asphyxiated near-term lambs

et al. 2015

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Background: Chest compressions (CC) and adrenaline administration are recommended in asphyxiated newborns with persistent bradycardia despite effective ventilation. The effects of CC on cerebral blood flow in newborns at birth are unknown. Our aim was to determine the effects of CC, with or without adrenaline administration, on the return of spontaneous circulation, carotid blood flow (CBF), and carotid arterial pressure (CAP) in asphyxiated near-term lambs. Methods: Asphyxia was induced in near-term lambs by clamping the umbilical cord and delaying ventilation onset until spontaneous circulation ceased. Lambs were then resuscitated by positive pressure ventilation along with CC followed by adrenaline administration. CAP and CBF were continuously recorded. results: Mean CAP did not increase significantly during CC and only increased following adrenaline administration. CC did not increase mean CBF but increased CBF amplitude due to increased peak flow and the onset of retrograde flow during diastole. Adrenaline increased mean CBF from 1 ± 2 to 15 ± 5 ml/kg/min and abolished retrograde diastolic CBF, leading to the return in spontaneous circulation. conclusion: We conclude that CC with adrenaline administration was required to increase CBF and restore spontaneous circulation in asphyxiated lambs. Low CBF and retrograde diastolic CBF during CC indicate hypoperfusion to the brain. a pproximately 5% of all newborns worldwide will require some form of assisted ventilation at birth and about 0.03% of newborns will require more advanced resuscitation such as intubation, chest compressions (CCs), and drug administration (1,2). Severely asphyxiated newborn infants are born bradycardic and apneic and require resuscitation to establish pulmonary gas exchange and restore cardiac function after birth. As the initiation of ventilation and the establishment of a functional capacity also trigger the increase in pulmonary blood flow at birth, it plays a dual role in severely asphyxiated newborn infants (3). That is, it is responsible for both increasing oxygenation and for facilitating the increase in cardiac output by providing preload for the left ventricle (3,4). If low cardiac output persists despite effective positive pressure ventilation, the newborn is likely to suffer increasingly severe hypoxia and acidemia, leading to hypoxic/ischemic injury. Continued asphyxia further depresses myocardial function, leading to low systolic and diastolic blood pressures despite a chemoreceptor-mediated peripheral vasoconstriction (5,6). Current international neonatal resuscitation guidelines recommend that if heart rate is less than 60 BPM despite effective positive pressure ventilation, CCs should be applied (7,8). CC will assist to mechanically pump blood until the myocardium is sufficiently oxygenated to recover spontaneous function (9). If heart rate remains below 60 BPM despite effective CC, then adrenaline should be administered (7,8).Given the infrequent use of CC and adrenaline, rigorous clinical studies to optimize CC and adren...

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“…The dyssynchrony also could increase the duty cycle. Animal studies have shown that 30% of compression duty cycle provides superior coronary and cerebral perfusion compared with 60% of duty cycle [24,25]. Under the consideration of practical and educational feasibility, guidelines suggest the optimal level to be a 50% of duty cycle [2].…”

Section: Discussionmentioning

confidence: 99%