BACKGROUND Current resuscitation guidelines recommend 3:1 C:V ratio, however the most effective C:V ratio in newborns remains controversial. We recently demonstrate that combining chest compressions (CC) with a sustained inflation (SI) (=CC+SI) significantly improves return of spontaneous circulation (ROSC) in asphyxiated newborn piglets compared to 3:1 C:V resuscitation. However, the optimal length of SI during CC+SI is unknown. OBJECTIVES To examine if a 60sec SI compared to a 20sec SI or 3:1 C:V will reduce will reduces ROSC during resuscitation in asphyxiated newborn piglets. DESIGN/METHODS Cardiac arrest with achieved was induced in newborn piglets and then randomized to receive either “3:1 C:V ratio, SI+CC-20sec” or “SS+CC-60sec”. Piglets randomized to “SI+CC+20sec” or “SI+CC+60sec” received 90/min CC during a SI of 20sec or 60sec. Piglets randomized to 3:1 C:V received 90/min CC and 30 inflations/min. The default settings for airway pressures were peak inflation pressure of 30 cm H2O and a positive end expiratory pressure of 6 cm H2O. The primary outcome was duration of CC to achieve ROSC. RESULTS Eight piglets were randomized to each group; the mean (SD) age and weight was similar between groups. Median (IQR) ROSC was significantly shorter in the SI+CC-20sec and SI+CC-60sec group with 96 (68–168) sec and 78 (60–91) sec compared to the 3:1 C:V group with 235 (182–347)sec (p=0.002). 5/8 in the SI+CC-60sec group, 7/8 in the SI+CC-20sec and 8/8 in the 3:1 C:V group received epinephrine (p=0.82). CONCLUSION Lengths of SI during CC+SI does not affect ROSC, however CC+SI compared to 3:1 C:V does improve ROSC in newborn piglets.
BACKGROUND Recent neonatal resuscitation guidelines have suggested the potential benefit of introducing Electrocardiography (ECG) to monitor neonatal heart rate (HR) as standard of care for newborns receiving respiratory support in the delivery room due to advantages over auscultation. OBJECTIVES To assess effectiveness of HR detection using either ECG or auscultation. DESIGN/METHODS We reviewed recordings from our piglet neonatal resuscitations to compare an ECG with auscultation for assessing the detection of HR at cardiac arrest. Term newborn piglets (n=41) were anesthetized, intubated, instrumented, and exposed to 40-min normocapnic hypoxia followed by asphyxia, which was achieved by clamping the endotracheal tube until asystole. Asystole was confirmed by using Electrocardiography and auscultation. RESULTS The median (±IQR) duration of asphyxia was 318 (200–560)sec. In 41 piglets both auscultation and ECG HR were assessed. In 11 (27%) cases both auscultation and ECG correctly identified a bradycardic HR (mean (SD) 32(14)/min) at the beginning of chest compression. In 11 (27%) cases both auscultation and ECG correctly identified absent of any HR. However, in 19 (46%) cases auscultation did not detect a HR while ECG did detect a HR. Overall, the Positive Predictive Value was 37%, Negative Predictive Value was 100%, Sensitivity was 100%, and Specificity was 37% for the ECG to display accurate HR during asphyxia in newborn piglets. CONCLUSION Our data illustrates the need for caution in the routine use of ECG monitoring for all neonatal who might need advanced resuscitation in the deliver room.
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