Tidal volume delivery during continuous chest compressions and sustained inflation

Solevåg, Anne Lee; Lee, TF; Lu, Mengji; Schmölzer, GM; Cheung, Po-Yin

doi:10.1136/archdischild-2016-311043

Cited by 17 publications

(21 citation statements)

References 7 publications

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“…Solevåg et al reported the need for a PIP of approximately 25 cmH 2 O to achieve adequate V T in piglet cadavers and determined distending pressure during CC+SI [28]. This study suggests that chest recoil produces an inflation pressuredependent V T allowing passive ventilation during CCs [28]. A similar observation was reported during chest recoil after the application of a downward force on the chest of infants undergoing surgery requiring general anesthesia [29].…”

Section: Discussionsupporting

confidence: 66%

“…Although there is sufficient evidence that an inflation pressure of 20 to 25 cmH 2 O delivers a high V T in preterm infants [13,14], no study has ever measured the optimal PIP and the delivery of adequate V T during CC in the delivery room. Solevåg et al reported the need for a PIP of approximately 25 cmH 2 O to achieve adequate V T in piglet cadavers and determined distending pressure during CC+SI [28]. This study suggests that chest recoil produces an inflation pressuredependent V T allowing passive ventilation during CCs [28].…”

Section: Discussionmentioning

confidence: 69%

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Effects of sustained inflation pressure during neonatal cardiopulmonary resuscitation of asphyxiated piglets

Shim

Kim

Cheung

et al. 2020

Preprint

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ObjectiveSustained inflation (SI) during chest compression (CC = CC+SI) significantly reduces time to return of spontaneous circulation (ROSC) compared to 3:1 compression-to-ventilation ratio during neonatal resuscitation. However, the optimal peak inflation pressure (PIP) of SI during CC+SI to improve ROSC and hemodynamic recovery in severely asphyxiated piglets is unknown.AimTo examine if different PIPs of SI during CC+SI will improve ROSC and hemodynamic recovery in severely asphyxiated piglets.Intervention and measurementsTwenty-nine newborn piglets (1-3 days old) were anesthetized, intubated, instrumented and exposed to 30-min normocapnic hypoxia followed by asphyxia. Piglets were randomized into four groups: CC+SI with a PIP of 10 cmH2O (CC+SI_PIP_10, n=8), a PIP of 20 cmH2O (CC+SI_PIP_20, n=8), a PIP of 30 cmH2O (CC+SI_PIP_30, n=8), and a sham-operated control group (n=5). Heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment.Main resultsBaseline parameters were similar between all groups. There was no difference in asphyxiation (duration and degree) between intervention groups. PIP correlated positively with tidal volume and inversely with exhaled CO2 during cardiopulmonary resuscitation. Time to ROSC and rate of ROSC were similar between piglets resuscitated with CC+SI_PIP_10, CC+SI_PIP_20, and CC+SI_PIP_30 cmH2O: median (IQR) 75 (63-193) sec, 94 (78-210) sec, and 85 (70-90) sec; 5/8 (63%), 7/8 (88%), and 3/8 (38%) (p=0.56 and p=0.12, respectively). All piglets that achieved ROSC survived to four hours post-resuscitation. Piglets resuscitated with CC+SI_PIP_30 cmH2O exhibited increased concentrations of pro-inflammatory cytokines interleukin-1β and tumour necrosis factor-α in the frontoparietal cerebral cortex (both p<0.05 vs. sham-operated controls).ConclusionsIn asphyxiated term newborn piglets resuscitated by CC+SI, the use of different PIPs resulted in similar time to ROSC, but PIP at 30 cmH2O showed a larger VT delivery, lower exhaled CO2 and increased tissue inflammatory markers in the brain.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 69%

Effects of sustained inflation pressure during neonatal cardiopulmonary resuscitation of asphyxiated piglets

Shim

Kim

Cheung

et al. 2020

Preprint

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“…During compression of the chest, volume is exhaled and during chest recoil, gas passively flows back into the lungs. The required distending pressure to achieve passive lung ventilation and adequate tidal volume delivery is ~25cmH2O, which correlated in cadaver piglets (r=0.83, p<0.001), manikins (r=0.98, p<0.001), and when combined (piglets + manikins) (r=0.49, p<0.001) 48 . A similar observation was reported during chest recoil after a downward force was applied to the chest of infants undergoing surgery requiring general anesthesia 49 .…”

Section: Chest Compression and Sustained Inflationmentioning

confidence: 94%

Chest Compressions in the Delivery Room

Garcia-Hidalgo

Schmölzer

2018

Preprint

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Annually, an estimated 13-26 million newborns need respiratory support and 2-3 million newborns need extensive resuscitation, defined as chest compression and 100% oxygen with or without epinephrine in the delivery room. Despite such care, there is a high incidence of mortality and short-term neurologic morbidity. The poor prognosis associated with receiving chest compression alone or with medications in the delivery room raises questions as to whether improved cardiopulmonary resuscitation methods specifically tailored to the newborn could improve outcomes. This review discusses the current recommendations, mode of action, different compression to ventilation ratio, continuous chest compression with asynchronous ventilations, chest compression and sustained inflation optimal depth, and oxygen concentration during cardiopulmonary resuscitation.

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“…Li et al reported that surviving piglets had significantly higher values of ETCO 2 , VCO 2 , and PECO 2 during CPR compared to non-surviving piglets, suggesting that continuously monitoring ETCO 2 , VCO 2 , and PECO 2 during CC has the potential to be a non-invasive method to indicate ROSC [40]. To further investigate if other parameters could be used as early outcome predictors after CPR, Solevåg et al examined if cerebral and renal tissue oxygen saturation was different between surviving piglets and non-surviving piglets that were resuscitated after asphyxiainduced cardiac arrest [41]. The relationship of the tissue oxygen saturations with cardiac output, blood pressure, and biochemical variables was also examined [41].…”

Section: Respiratory Parametersmentioning

confidence: 99%

“…To further investigate if other parameters could be used as early outcome predictors after CPR, Solevåg et al examined if cerebral and renal tissue oxygen saturation was different between surviving piglets and non-surviving piglets that were resuscitated after asphyxiainduced cardiac arrest [41]. The relationship of the tissue oxygen saturations with cardiac output, blood pressure, and biochemical variables was also examined [41]. No correlation between cardiac output or blood pressure and cerebral or renal tissue oxygen saturation was observed.…”

Section: Respiratory Parametersmentioning

confidence: 99%

A Porcine Model of Neonatal Hypoxia-Asphyxia to Study Resuscitation Techniques in Newborn Infants

O’Reilly¹,

Cheung²,

Lee³

et al. 2020

Animal Models in Medicine and Biology

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Two to three million newborn infants worldwide need extensive cardiopulmonary resuscitation (CPR), and approximately one million of these infants die annually worldwide. Therefore, resuscitation techniques require further refinement to provide better outcomes. To investigate the effectiveness of various interventions and to understand the pathophysiology and pharmacology of neonatal CPR, it is important to have animal models that reliably reproduce features observed in neonates who require resuscitation. Herein, we describe an experimental animal model in newborn piglets that simulates neonatal asphyxia and enables us to examine resuscitation interventions, reoxygenation, and recovery processes. The newborn piglet has several advantages including similar development to a human fetus at 36-38 week's gestation, and comparable body systems and body size, allowing for surgical instrumentation, monitoring, and collection of biological samples. Furthermore, using this model of neonatal asphyxia, we are also able to describe an increasingly important clinical situation in the laboratory setting-pulseless electrical activity (PEA). Since the integration of electrocardiogram into the neonatal resuscitation guidelines, there has been an increased awareness of PEA in newborn infants. The animal model we describe can therefore serve as a valuable tool to bridge the knowledge gap and improve the outcome of asphyxiated newborns in the delivery room.

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Tidal volume delivery during continuous chest compressions and sustained inflation

Abstract: Chest recoil generates V depending on an adequate distending pressure. This has previously been demonstrated in adult animals. A pressure of ∼25 cm HO is needed to achieve an adequate V delivery.

Cited by 17 publications

References 7 publications

Effects of sustained inflation pressure during neonatal cardiopulmonary resuscitation of asphyxiated piglets

Effects of sustained inflation pressure during neonatal cardiopulmonary resuscitation of asphyxiated piglets

Chest Compressions in the Delivery Room

A Porcine Model of Neonatal Hypoxia-Asphyxia to Study Resuscitation Techniques in Newborn Infants

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