Myocardial perfusion and oxidative stress after 21% vs. 100% oxygen ventilation and uninterrupted chest compressions in severely asphyxiated piglets

Solevåg, Anne Lee; Schmölzer, Georg M.; O’Reilly, Megan; Lu, Minjie; Lee, Tze-Fun; Hornberger, Lisa K.; Nakstad, Britt; Cheung, Po-Yin

doi:10.1016/j.resuscitation.2016.06.014

Cited by 50 publications

(66 citation statements)

References 25 publications

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“…While this approach differs from the current neonatal resuscitation guidelines, it is in accordance with previous studies reporting that administering 21% oxygen during CC is equal to administering 100% oxygen [20,21]. Indeed, the CC+SI 90 group required an increase to 100% oxygen less often.…”

Section: Discussionsupporting

confidence: 69%

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Görens²,

Cheung³

et al. 2017

Neonatology

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Background: Recently, sustained inflations (SI) during chest compression (CC) (CC+SI) have been suggested as an alternative to the current approach during neonatal resuscitation. No previous study compared CC+SI using CC rates of 90/min to the current 3:1 compression:ventilation ratio (C:V). Objective: To determine whether CC+SI versus a 3:1 C:V reduces the time to the return of spontaneous circulation (ROSC) and improves hemodynamic recovery in newborn piglets with asphyxia-induced bradycardia. Intervention and Measurements: Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-min normocapnic hypoxia followed by asphyxia. Cardiopulmonary resuscitation (CPR) was initiated when the heart rate decreased to 25% of baseline. Piglets were randomized into 3 groups: CC during SI at a rate of 90 CC/min (SI+CC 90, n = 8), a 3:1 C:V using 90 CC and 30 inflations (3:1, n = 8), or a sham group (n = 6). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. Results: CC+SI significantly reduced the median (IQR) time of ROSC, i.e., 34 s (28-156 s) versus 210 s (72-300 s) in the 3:1 group (p = 0.048). CC+SI also significantly reduced the requirement for 100% oxygen, improved respiratory parameters, and resulted in a similar hemodynamic recovery. Conclusions: CC+SI during CPR significantly improved ROSC in a porcine model of neonatal resuscitation. This is of considerable clinical relevance because improved respiratory and hemodynamic parameters potentially minimize morbidity and mortality in newborn infants.

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Section: Discussionsupporting

confidence: 69%

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Görens²,

Cheung³

et al. 2017

Neonatology

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“…CO (mL/kg/min) was calculated off-line from recordings made at baseline and 30 min and 4 h after ROSC as described previously [15]. …”

Section: Methodsmentioning

confidence: 99%

“…Asphyxia was induced as described by Solevåg et al [15] by reducing FiO 2 to 0.08 and reducing the ventilator rate by 10/min every 10 min until a rate of 0/min. After 10 min with persistent positive end-expiratory pressure of 5 cm H 2 O, the ventilator was disconnected and the endotracheal tube clamped until pulseless electrical activity (PEA) [15].…”

Section: Methodsmentioning

confidence: 99%

“…After 10 min with persistent positive end-expiratory pressure of 5 cm H 2 O, the ventilator was disconnected and the endotracheal tube clamped until pulseless electrical activity (PEA) [15]. …”

Section: Methodsmentioning

confidence: 99%

“…The study is based on secondary analyses of a ROSC study in asphyxiated piglets [15], and no sample size calculation was performed for rScO 2 and rSrO 2 . Continuous variables are presented as medians (interquartile range [IQR]).…”

Section: Methodsmentioning

confidence: 99%

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Association between Brain and Kidney Near-Infrared Spectroscopy and Early Postresuscitation Mortality in Asphyxiated Newborn Piglets

Solevåg

Schmölzer²,

Nakstad³

et al. 2017

Neonatology

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Background: Early outcome predictors after delivery room cardiopulmonary resuscitation (CPR) of asphyxiated newborns are needed. Objectives: To investigate if cerebral (rScO₂) and renal (rSrO₂) tissue oxygen saturation 30 min after return of spontaneous circulation (ROSC) are different between surviving versus nonsurviving piglets with asphyxia-induced cardiac arrest and CPR. Further, to investigate the relationship of rScO₂ and rSrO₂ to cardiac output (CO), blood pressure (BP), and biochemical variables 30 min and 4 h after ROSC. Methods: Anesthetized, mechanically ventilated piglets (1-3 days, 1.7-2.4 kg) were used. rScO₂, rSrO₂, SpO₂, right common carotid artery flow, and arterial BP were measured continuously. CO was measured with echocardiography. The piglets were asphyxiated until cardiac arrest and resuscitated. Piglets that survived 4 h after ROSC (n = 12) were compared with piglets that died before planned euthanasia at 4 h (n = 13). Left ventricular, and kidney and brain tissue lactate were analyzed. Correlations between variables were assessed. Results: Thirty minutes after ROSC, median rSrO₂ (43% [n = 10] vs. 25% [n = 2], p = 0.003) but not rScO₂ (46% [41-55] [n = 10] vs. 40% [22-45] [n = 5], p = 0.08) was higher in survivors than in nonsurvivors. Arterial lactate was negatively correlated and pH positively correlated with rScO₂ and rSrO₂. Left ventricular, but not kidney or brain lactate was negatively correlated with rScO₂ and rSrO₂. There was no correlation between CO or BP and rScO₂ or rSrO₂. Conclusions: Despite satisfactory CO and BP vital organ oxygenation can be poor. Tissue oxygen saturation, pH, and lactate, as measures of anaerobic metabolism, may reflect vital organ oxygenation and outcome.

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Normoxic post-ROSC ventilation delays hippocampal CA1 neurodegeneration in a rat cardiac arrest model, but does not prevent it

et al. 2020

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Myocardial perfusion and oxidative stress after 21% vs. 100% oxygen ventilation and uninterrupted chest compressions in severely asphyxiated piglets

Cited by 50 publications

References 25 publications

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Association between Brain and Kidney Near-Infrared Spectroscopy and Early Postresuscitation Mortality in Asphyxiated Newborn Piglets

Normoxic post-ROSC ventilation delays hippocampal CA1 neurodegeneration in a rat cardiac arrest model, but does not prevent it

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