The Effect of Asphyxia Arrest Duration on a Pediatric End-Tidal co 2-Guided Chest Compression Delivery Model*

Hamrick, Jennifer L.; Hamrick, Justin; O’Brien, Caitlin E.; Reyes, Michael; Santos, Polan T.; Heitmiller, Sophie E; Kulikowicz, Ewa; Lee, Jennifer K.; Kudchadkar, Sapna R.; Koehler, Raymond C.; Hunt, Elizabeth A.; Shaffner, Donald H.

doi:10.1097/pcc.0000000000001968

Cited by 11 publications

(17 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We also found an effect of asphyxia duration on the use of ETCO 2 ‐guided CPR. We found that, like our 20‐minute arrest study, after a 17‐minute asphyxia and fibrillation arrest the rate of ROSC was higher in the ETCO 2 ‐guided CPR group than in the standard CPR group (64% vs 21%, P = .05) but, after a 23‐minute arrest, ETCO 2 ‐guided CPR was as ineffective as standard CPR (7% vs 21%) . We use an asphyxial cardiac arrest model because respiratory insufficiency is one of the most common causes of pediatric cardiac arrest, including arrest in the operating room .…”

Section: Introductionmentioning

confidence: 62%

“…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a retrospective, secondary analysis of data from piglet cardiac arrest studies that we published previously as well as unpublished studies.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%

“…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20‐minute asphyxia model, 56 were reported in a 17‐minute and 23‐minute asphyxia comparison, and 70 are included in an unpublished comparison of five asphyxia durations.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 .…”

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%

See 4 more Smart Citations

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

Self Cite

View full text Add to dashboard Cite

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

show abstract

Section: Introductionmentioning

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations