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

Abstract

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.

Single versus continuous sustained inflations during chest compressions and physiological-based cord clamping in asystolic lambs

“…Previous studies have found that continuous CC provides better minute ventilation and a faster recovery of CBF than the standard 3:1 C:V approach. 19–21 We did not observe any differences between groups that would indicate that the different CC approaches had an influence on our findings, but the study was not designed to explicitly detect potential differences due to CC technique.…”