Continuous End-Tidal Carbon Dioxide Monitoring during Resuscitation of Asphyxiated Term Lambs

Chandrasekharan, Praveen; Rawat, Munmun; Nair, Jayasree; Gugino, Sylvia F.; Koenigsknecht, Carmon; Swartz, Daniel D.; Vali, Payam; Mathew, Bobby; Lakshminrusimha, Satyanarayana

doi:10.1159/000443303

Cited by 15 publications

(11 citation statements)

References 33 publications

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“…They were intubated with a 10.0 mm-cuffed endotracheal tube (ETT) and ventilated with 21% oxygen and 2–3% isoflurane at 16 breaths/min. The ewes were continuously monitored with a pulse oximeter and an end-tidal CO 2 (EtCO 2 ) monitor [9,10]. Following cesarean section, fetal lambs were partially exteriorized and intubated with a 4.5 mm-cuffed ETT as previously described [11].…”

Section: Methodsmentioning

confidence: 99%

Oxygenation and Hemodynamics during Chest Compressions in a Lamb Model of Perinatal Asphyxia Induced Cardiac Arrest

et al. 2019

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The current guidelines recommend the use of 100% O2 during resuscitation of a neonate requiring chest compressions (CC). Studies comparing 21% and 100% O2 during CC were conducted in postnatal models and have not shown a difference in incidence or timing of return of spontaneous circulation (ROSC). The objective of this study is to evaluate systemic oxygenation and oxygen delivery to the brain during CC in an ovine model of perinatal asphyxial arrest induced by umbilical cord occlusion. Pulseless cardiac arrest was induced by umbilical cord occlusion in 22 lambs. After 5 min of asystole, lambs were resuscitated with 21% O2 as per Neonatal Resuscitation Program (NRP) guidelines. At the onset of CC, inspired O2 was either increased to 100% O2 (n = 25) or continued at 21% (n = 9). Lambs were ventilated for 30 min post ROSC and FiO2 was gradually titrated to achieve preductal SpO2 of 85–95%. All lambs achieved ROSC. During CC, PaO2 was 21.6 ± 1.6 mm Hg with 21% and 23.9 ± 6.8 mm Hg with 100% O2 (p = 0.16). Carotid flow was significantly lower during CC (1.2 ± 1.6 mL/kg/min in 21% and 3.2 ± 3.4 mL/kg/min in 100% oxygen) compared to baseline fetal levels (27 ± 9 mL/kg/min). Oxygen delivery to the brain was 0.05 ± 0.06 mL/kg/min in the 21% group and 0.11 ± 0.09 mL/kg/min in the 100% group and was significantly lower than fetal levels (2.1 ± 0.3 mL/kg/min). Immediately after ROSC, lambs ventilated with 100% O2 had higher PaO2 and pulmonary flow. It was concluded that carotid blood flow, systemic PaO2, and oxygen delivery to the brain are very low during chest compressions for cardiac arrest irrespective of 21% or 100% inspired oxygen use during resuscitation.

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Section: Methodsmentioning

confidence: 99%

Oxygenation and Hemodynamics during Chest Compressions in a Lamb Model of Perinatal Asphyxia Induced Cardiac Arrest

et al. 2019

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“…We have previously shown that ETCO 2 correlated well with PaCO 2 in an ovine meconium aspiration model poststabilization (11). In this study using an asphyxia model, ETCO 2 correlated well with PaCO 2 after 5 min of established ROSC.…”

Section: Discussionmentioning

confidence: 93%

“…We have previously demonstrated that use of capnography in addition to arterial carbon dioxide (PaCO 2 ) monitoring in a term lamb model of meconium aspiration resulted in maintenance of carbon dioxide in a narrower range and prevented fluctuation of carotid blood flow (11). From our pilot studies, using an asphyxiated cardiac arrest model in which active resuscitation was uninterrupted, we noted that changes in end-tidal carbon dioxide (ETCO 2 ) reflected gas exchange and also helped predict ROSC.…”

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Continuous capnography monitoring during resuscitation in a transitional large mammalian model of asphyxial cardiac arrest

et al. 2017

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BACKGROUND In neonates requiring chest compression (CC) during resuscitation, neonatal resuscitation program (NRP) recommends against relying on a single feedback device such as end-tidal carbon dioxide (ETCO2) or saturations (SpO2) to determine return of spontaneous circulation (ROSC) until more evidence becomes available. METHODS We evaluated the role of monitoring ETCO2 during resuscitation in a lamb model of cardiac arrest induced by umbilical cord occlusion (n = 21). Lambs were resuscitated as per NRP guidelines. Systolic blood pressure (SBP), carotid and pulmonary blood flows along with ETCO2 and blood gases were continuously monitored. Resuscitation was continued for 20 min or until ROSC (whichever was earlier). Adequate CC was arbitrarily defined as generation of 30 mmHg SBP during resuscitation. ETCO2 thresholds to predict adequacy of CC and detect ROSC were determined. RESULTS Significant relationship between ETCO2 and adequate CC was noted during resuscitation (AUC-0.735, P < 0.01). At ROSC (n = 12), ETCO2 rapidly increased to 57 ± 20 mmHg with a threshold of ≥32 mmHg being 100% sensitive and 97% specific to predict ROSC. CONCLUSION In a large mammalian model of perinatal asphyxia, continuous ETCO2 monitoring predicted adequacy of CC and detected ROSC. These findings suggest ETCO2 in conjunction with other devices may be beneficial during CC and predict ROSC.

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“…We targeted preductal saturations based on current NRP recommendations ( 3 ). A respiratory monitor (NM3 Philips, Respironics, MA) with a mainstream end-tidal carbon dioxide detector (ETCO 2 ) was attached to the tracheal tube ( 13 , 14 ). Cerebral saturation was measured by NONIN (SenSmart Model X-100, Plymouth, MN) regional oximetry.…”

Section: Methodsmentioning

confidence: 99%

Effect of various inspired oxygen concentrations on pulmonary and systemic hemodynamics and oxygenation during resuscitation in a transitioning preterm model

et al. 2018

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Background The Neonatal Resuscitation Program recommends initial resuscitation of preterm infants with low oxygen (O2) followed by titration to target preductal saturations (SpO2). We studied the effect of resuscitation with titrated O2 on gas exchange, pulmonary and systemic hemodynamics. Methodology Twenty-nine preterm lambs (127d-gestation) were randomized to resuscitation with 21%O2 (n=7), 100%O2 (n=6) or initiation at 21% and titrated to target SpO2 (n=16). Seven healthy term control lambs were ventilated with 21%O2. Results Preductal SpO2 achieved by titrating O2 was within the desired range similar to term lambs in 21%O2. Resuscitation of preterm lambs with 21 and 100%O2 resulted in SpO2 below and above the target respectively. Ventilation of preterm lambs with 100%O2 and term lambs with 21%O2 effectively decreased pulmonary vascular resistance (PVR). In contrast, preterm lambs with 21%O2 and titrated O2 demonstrated significantly higher PVR than term lambs on 21%O2. Conclusion(s) Initial resuscitation with 21%O2 followed by titration of O2 led to suboptimal pulmonary vascular transition at birth in preterm lambs. Ventilation with 100%O2 in preterm lambs caused hyperoxia but reduced PVR similar to term lambs on 21%O2. Studies evaluating initiation of resuscitation at higher O2 concentration followed by titration based on SpO2 in preterm neonates are needed.

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Continuous End-Tidal Carbon Dioxide Monitoring during Resuscitation of Asphyxiated Term Lambs

Cited by 15 publications

References 33 publications

Oxygenation and Hemodynamics during Chest Compressions in a Lamb Model of Perinatal Asphyxia Induced Cardiac Arrest

Oxygenation and Hemodynamics during Chest Compressions in a Lamb Model of Perinatal Asphyxia Induced Cardiac Arrest

Continuous capnography monitoring during resuscitation in a transitional large mammalian model of asphyxial cardiac arrest

Effect of various inspired oxygen concentrations on pulmonary and systemic hemodynamics and oxygenation during resuscitation in a transitioning preterm model

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