Asynchronous ventilation at 120 compared with 90 or 100 compressions per minute improves haemodynamic recovery in asphyxiated newborn piglets

Patel, Sparsh; Cheung, Po–Yin; Lee, Tze-Fun; Pasquin, Matteo; Lu, Minjie; O’Reilly, Megan; Schmölzer, Georg M.

doi:10.1136/archdischild-2018-316610

Cited by 18 publications

(18 citation statements)

References 26 publications

(44 reference statements)

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“…Piglets in the CCaV + 90 and CCaV + 100 had higher brain IL-1β and IL-6. Cortical lactate levels were significantly higher in the CCaV + 90 and CCaV + 100 groups compared with the CCaV + 120 group, which corresponded with plasma lactate levels at the end of the 4-h recovery period [38].…”

Section: Continuous Chest Compression With Asynchronous Ventilationmentioning

confidence: 61%

“…In asphyxiated piglets and lambs, different CC approaches have been investigated as alternatives to the standard 3:1 C:V ratio including different C:V ratios 2:1 [33], 4:1 [33], 9:3 [34], and 15:2 [35], continuous CC with asynchronous ventilations (CCaV) [36,37] at different CC rates (90/min, 100/min and 120/min) [38], and continuous CC with sustained inflation (SI) [39][40][41] at different CC rates [42] and SI duration [43].…”

Section: Cerebral Blood Flow During Different Ways Of Performing CCmentioning

confidence: 99%

“…Patel et al [38] examined whether different CC rates during CCaV would change time to ROSC and survival in asphyxiated piglets. Hemodynamic recovery of CCaV with a CC rate 120/min (CCaV + 120) (n = 8) was significantly improved compared with CCaV + 90 (n = 8) and CCaV + 100 (n = 8).…”

Section: Continuous Chest Compression With Asynchronous Ventilationmentioning

confidence: 99%

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Chest Compression in Neonatal Cardiac Arrest: Cerebral Blood Flow Measurements in Experimental Models

2020

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The main aim of this paper was to provide an overview of studies that measured cerebral blood flow (CBF), directly or indirectly, during chest compression (CC) in neonatal animals. Our main research question was: how did different ways of performing CC influence CBF. We also aimed to discuss strengths and limitations of different methods for measuring CBF. Based on a search in Medline Ovid, we identified three studies in piglets that investigated different CC:ventilation (C:V) ratios, as well as three piglet studies investigating continuous CC with asynchronous ventilation. CBF was measured indirectly in all studies by means of carotid artery (CA) flow and regional cerebral oxygenation (rcSO2). The CA provides flow to the brain, but also to extracerebral structures. The relative sizes of the internal and external carotid arteries and their flow distributions are species-dependent. rcSO2 is a non-invasive continuous measure, but does not only reflect CBF, but also cerebral blood volume and the metabolic rate of oxygen in the brain. Continuous CC with asynchronous ventilation at a CC rate of 120/min, and combining CC with a sustained inflation (four studies in piglets and one in lambs) provided a faster CBF recovery compared with the standard 3:1 C:V approach.

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Section: Continuous Chest Compression With Asynchronous Ventilationmentioning

confidence: 61%

Section: Cerebral Blood Flow During Different Ways Of Performing CCmentioning

confidence: 99%

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Chest Compression in Neonatal Cardiac Arrest: Cerebral Blood Flow Measurements in Experimental Models

2020

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“…This suggests that asynchronous ventilation during continuous CC is not more beneficial to the standard 3:1 C:V technique. In a following study, Patel et al examined whether the outcome will improve by using different CC rates with asynchronous ventilation, namely 90/min, 100/min, and 120/min [32]. Even though rate and time to ROSC were similar between groups, increasing the CC rate to 120/min with asynchronous ventilation significantly improved hemodynamic recovery, as indicated by CBF, and cerebral and renal perfusion [32].…”

Section: Asynchronous Ventilationmentioning

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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“…Additional doses of propofol (1-2 mg/kg) and morphine (0.05-0.1 mg/kg) were also given as needed. The piglet's body temperature was maintained at 38.5-39.5 • C using an overhead warmer and a heating pad (20)(21)(22)(23)(24)(25)(26).…”

Section: Animal Preparationmentioning

confidence: 99%

Asphyxiated Female and Male Newborn Piglets Have Similar Outcomes With Different Cardiopulmonary Resuscitation Interventions

et al. 2020

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Background: Male newborns have a greater risk of poor cardiovascular and respiratory outcomes compared to females. The mechanisms associated with the “male disadvantage” remains unclear. We have previously shown no difference between male and female newborn piglets during hypoxia, asphyxia, resuscitation, and post-resuscitation recovery. However, it is unknown if there are differences in resuscitation outcomes between males and females during different cardiopulmonary resuscitation techniques.Intervention and Measurements: Secondary analysis of 184 term newborn mixed breed duroc piglets (1–3 days of age, weighing 2.0 (0.2) kg) from seven different studies, which were exposed to 30–50 min of normocapnic hypoxia followed by asphyxia until asystole. This was followed by cardiopulmonary resuscitation. For the analysis, piglets were divided into male and female groups, as well as resuscitation technique groups (sustained inflation, 3:1 compression-to-ventilation ratio, or asynchronous ventilations during chest compressions). Cardiac function, carotid blood flow, and cerebral oxygenation were continuously recorded throughout the experiment.Main results: Regardless of resuscitation technique, there was no significant difference between males and females in the number achieving return of spontaneous circulation (ROSC) [95/123 (77%) vs. 48/61 (79%)], the time to achieve ROSC [112 (80–185) s vs. 110 (77–186) s], and the 4-h survival rate [81/95 (85%) vs. 40/48 (83%)]. Levels of the injury markers interleukin (IL)−1ß, IL-6, IL-8, and tumor necrosis factor-α in frontoparietal cortex tissue homogenates were similar between males and females.Conclusions: Regardless of resuscitation technique, there was no significant effect of sex on resuscitation outcome, survival, and hemodynamic recovery in asphyxiated newborn piglets.

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Asynchronous ventilation at 120 compared with 90 or 100 compressions per minute improves haemodynamic recovery in asphyxiated newborn piglets

Cited by 18 publications

References 26 publications

Chest Compression in Neonatal Cardiac Arrest: Cerebral Blood Flow Measurements in Experimental Models

Chest Compression in Neonatal Cardiac Arrest: Cerebral Blood Flow Measurements in Experimental Models

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

Asphyxiated Female and Male Newborn Piglets Have Similar Outcomes With Different Cardiopulmonary Resuscitation Interventions

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