Abstract
Aim
Despite the minimal evidence, neonatal resuscitation guidelines recommend using 100%
oxygen when chest compressions (CC) are needed. Uninterrupted CC in adult cardiopulmonary
resuscitation (CPR) may improve CPR hemodynamics. We aimed to examine 21% oxygen (air)
vs. 100% oxygen in 3:1 CC:ventilation (C:V) CPR or continuous CC with asynchronous
ventilation (CCaV) in asphyxiated newborn piglets following cardiac arrest.
Methods
Piglets (1–3 days old) were progressively asphyxiated until cardiac arrest and randomized
to 4 experimental groups (n = 8 each): air and 3:1 C:V CPR, 100% oxygen and 3:1 C:V CPR, air and CCaV, or 100% oxygen
and CCaV. Time to return of spontaneous circulation (ROSC), mortality, and clinical
and biochemical parameters were compared between groups. We used echocardiography
to measure left ventricular (LV) stroke volume at baseline, at 30 min and 4 h after ROSC. Left common carotid artery blood pressure was measured continuously.
Results
Time to ROSC (heart rate ≥100 min−1) ranged from 75 to 592 s and mortality 50–75%, with no differences between groups. Resuscitation with air
was associated with higher LV stroke volume after ROSC and less myocardial oxidative
stress compared to 100% oxygen groups. CCaV was associated with lower mean arterial
blood pressure after ROSC and higher myocardial lactate than those of 3:1 C:V CPR.
Conclusion
In neonatal asphyxia-induced cardiac arrest, using air during CC may reduce myocardial
oxidative stress and improve cardiac function compared to 100% oxygen. Although overall
recovery may be similar, CCaV may impair tissue perfusion compared to 3:1 C:V CPR.
Abbreviations:
CC (chest compressions), CPR (cardiopulmonary resuscitation), CCaV (continuous CC and asynchronous ventilation), C:V (chest compression to ventilation), ILCOR (International Liaison Committee on Resuscitation), ROSC (return of spontaneous circulation), SpO2 (oxygen saturation), HR (heart rate), paCO2 (partial arterial CO2), ETCO2 (end-tidal CO2), VT (tidal volume), CO (cardiac output), LVOT (left ventricular outflow tract), PW (pulsed wave), SV (stroke volume), CPAP (continuous positive airway pressure), PEEP (positive end-expiratory pressure), PEA (pulseless electrical activity), PPV (positive pressure ventilation), MMP (matrix metalloproteinase), GSH (glutathione), GSSG (oxidized glutathione)Keywords
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Article info
Publication history
Published online: June 21, 2016
Accepted:
June 14,
2016
Received in revised form:
April 17,
2016
Received:
November 24,
2015
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2016.06.014.
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
