Ultra-low tidal volume ventilation—A novel and effective ventilation strategy during experimental cardiopulmonary resuscitation

Ruemmler, Robert; Ziebart, Alexander; Moellmann, Christian; García-Bardon, Andreas; Kamuf, Jens; Kuropka, Frances; Duenges, Bastian; Hartmann, Erik K.

doi:10.1016/j.resuscitation.2018.08.031

Cited by 34 publications

(77 citation statements)

References 27 publications

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“…In none of the studies did the use of 20 bpm result in hypocarbia from excessive ventilation that might lead to neurologic injury. Our findings resemble those of another study, which showed that the use of mechanical ventilation with low tidal volume and high respiratory rate during CPR resulted in adequate gas exchange and reduced intrathoracic pressures …”

Section: Discussionsupporting

confidence: 89%

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: Discussionsupporting

confidence: 89%

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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“…Additionally, the compromised pulmonary function depicted by MIGET measurements even before the rst de brillation already hinted at possible thoracic damage or at least insu cient perfusion, although this was neither con rmed by substantial differences in mean arterial blood pressures nor oxygenation impairments between the groups. While MIGET measurements are sophisticated, our group has shown their validity during CPR before (13) . Yet, since no other experimental group uses the technique in this context, systematic aws cannot fully be excluded.…”

Section: Discussionmentioning

confidence: 98%

“…Depending on no-ow time, time to drug administration and de brillation methods as well as ventilation settings, ROSC rates ranging from 30% to over 80% are regularly reported (26,27) . While differences between groups can occur randomly and might be due to the small sample sizes (13) , they usually do not reach statistical signi cance. However, the fact that not one animal survived after mCCD2 treatment combined with the damage severity con rmed in those animals causes our group to be con dent that those results are sound.…”

Section: Discussionmentioning

confidence: 99%

“…Ventilation/perfusion (V A /Q) analyses were performed at base line and during CPR (at "BLS") using the micropore membrane inlet mass spectrometry facilitated multiple inert gas elimination technique (MMIMS-MIGET, Oscillogy LLC, Philadelphia, USA) as described before (13) . In short, subclinical, non-toxic doses of a saline solution containing six chemically inert gases with different elimination constants (sulphur hexa uoride, krypton, des urane, en urane, diethyl ether and acetone) were infused starting 20 minutes prior to measurements in order to reach an in vivo steady state.…”

Section: Measurements/sample Collectionmentioning

confidence: 99%

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Standardized Post-Resuscitation Damage Assessment of Two Mechanical Chest Compression Devices: A Prospective Randomized Large Animal Trial

Ruemmler

Stein²,

Duenges³

et al. 2020

Preprint

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Abstract Background Mechanical chest compression devices are accepted alternatives for cardiopulmonary resuscitation (CPR) under specific circumstances. Current devices lack prospective and comparative data on their specific cardiovascular effects and potential for severe thoracic injuries. Objectives To compare CPR effectiveness and thoracic injuries of two mechanical chest compression devices in pigs. Study design: Prospective randomised trial Animals: 18 male German landrace pigs Methods Ventricular fibrillation was induced in anaesthetised and instrumented pigs and the animals were randomised into two intervention groups. Mechanical CPR was initiated by means of LUCAS™ 2 (mCCD1) or Corpuls™ cpr (mCCD2) device. Advanced life support was applied for a maximum of 10 cycles and animals achieving ROSC were monitored for 8 hours. Ventilation/perfusion measurements were performed and blood gas analyses were taken. Thoracic injuries were assessed via a standardised damage score. Results Five animals of the mCCD1 group and one animal of the mCCD2 group achieved ROSC (p = 0.048). Only the mCCD1 animals survived until the end of the monitoring period (p < 0.01). MCCD1 animals showed less pulmonary shunt (p = 0.025) and higher normal V/Q (p = 0.017) during CPR. MCCD2 animals showed significantly more severe thoracic injuries (p = 0.046). Conclusion The LUCAS 2 device shows superior resuscitation outcomes and less thoracic injuries compared to Corpuls cpr when used for experimental CPR in juvenile pigs. Researchers should be aware that different mCCDs for experimental studies may significantly influence the respective outcome of resuscitation studies and affect comparability of different trials. Controlled human and animal CPR studies and a standardised post-resuscitation injury evaluation could help to confirm potential hazards.

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“…Thirty male German landrace pigs (12-16 weeks, 28-35kg) were acquired from a local farm and received pre-transport sedation via an intramuscular injection of azaperone (2mg kg -1 ) and ketamine (4mg kg -1 ). Once in our Large Animal Research Facility, anaesthesia was induced via an ear cannula (22G) by injecting fentanyl (4µg kg -1 ), propofol (4mg kg -1 ) and atracurium (0.5mg kg -1 ) as described before [18]. During the whole experiment, anaesthesia was maintained via continuous infusion of propofol (5-10mg kg -1 h -1 ) and fentanyl (8-12µg kg -1 h -1 ) as well as a balanced electrolyte infusion (5ml kg -1 h -1 ).…”

Section: Anaesthesiamentioning

confidence: 99%

Flexible Fibreoptic Intubation in Swine – Improvement for Resident Training and Animal Safety Alike

Ruemmler

Ziebart

Ott

et al. 2020

Preprint

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Background: Efficient airway management to facilitate tracheal intubation encompasses essential skills in anaesthesiologic and intensive care. The application of flexible fibreoptic intubation in patients with difficult airways has been identified as the recommended method in various international guidelines. However, providing the opportunity to adequately train residents can be challenging. Using large animals for practice during ongoing studies could help to improve this situation, but there is no recent data on fibreoptic intubation in swine available. Methods: 30 male German landrace pigs were anesthetized, instrumented and randomized into two groups. The animals were either intubated conventionally using direct laryngoscopy or a single-use flexible video-endoscope. The intervention was carried out by providers with 3 months experience in conventional intubation of pigs and a brief introduction into endoscopy. Intubation attempts were supervised and aborted, when SpO2 dropped below 93%. After three failed attempts, an experienced supervisor intervened and performed the intubation. Intubation times and attempts were recorded and analysed.Results: Flexible fibreoptic intubation showed a significantly higher success rate in first attempt endotracheal tube placement (75% vs. 47%) with less attempts overall (1.3±0.6 vs. 2.1±1.3, P=0.043). Conventional intubation was faster (42s±6s vs. 67s±10s, P<0.001), but showed a higher complication rate and more desaturation episodes during the trial.Conclusions: Flexible fibreoptic intubation in swine is feasible and appears to be a safer and more accessible method for inexperienced users to learn. This could not only improve resident training options in hospitals with animal research facilities but might also prevent airway complications and needless animal suffering.

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Ultra-low tidal volume ventilation—A novel and effective ventilation strategy during experimental cardiopulmonary resuscitation

Cited by 34 publications

References 27 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

Standardized Post-Resuscitation Damage Assessment of Two Mechanical Chest Compression Devices: A Prospective Randomized Large Animal Trial

Flexible Fibreoptic Intubation in Swine – Improvement for Resident Training and Animal Safety Alike

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