IMPACT OF DIFFERENT VENTILATION STRATEGIES ON GAS EXCHANGES AND CIRCULATION DURING PROLONGED MECHANICAL CARDIO-PULMONARY RESUSCITATION IN A PORCINE MODEL.
Journal
Shock (Augusta, Ga.)
ISSN: 1540-0514
Titre abrégé: Shock
Pays: United States
ID NLM: 9421564
Informations de publication
Date de publication:
01 08 2022
01 08 2022
Historique:
pubmed:
29
10
2021
medline:
30
9
2022
entrez:
28
10
2021
Statut:
ppublish
Résumé
Background: Optimal ventilation during cardio-pulmonary resuscitation (CPR) is still controversial. Ventilation is expected to provide sufficient arterial oxygen content and adequate carbon dioxide removal, while minimizing the risk of circulatory impairment. The objective of the present study was to compare three ventilation strategies in a porcine model during mechanical continuous chest compressions (CCC) according to arterial oxygenation and hemodynamic impact. Method: Ventricular fibrillation was induced and followed by five no-flow minutes and thirty low-flow minutes resuscitation with mechanical-CCC without vasopressive drugs administration. Three groups of eight Landras pig were randomized according to the ventilation strategy: 1. Standard nonsynchronized volume-control mode (SD-group); 2. synchronized bilevel pressure-controlled ventilation (CPV-group); 3. continuous insufflation with Boussignac Cardiac-Arrest Device (BC-group). We assessed 1. arterial blood gases, 2. macro hemodynamics, 3. tissular cerebral macro and micro-circulation and 4. airway pressure, minute ventilation at baseline and every 5 minutes during the protocol. Results: Arterial PaO2 level was higher at each measurement time in SD-group (>200 mm Hg) compare to CPV-group and BC-group ( P < 0.01). In BC-group, arterial PaCO2 level was significantly higher (>90mm Hg) than in SD and CPV groups ( P < 0.01). There was no difference between groups concerning hemodynamic parameters, cerebral perfusion and microcirculation. Conclusion: Ventilation modalities in this porcine model of prolonged CPR influence oxygenation and decarboxylation without impairing circulation and cerebral perfusion. Synchronized bi-level pressure-controlled ventilation' use avoid hyperoxia and was as efficient as asynchronized volume ventilation to maintain alveolar ventilation and systemic perfusion during prolonged CPR.
Identifiants
pubmed: 34710880
doi: 10.1097/SHK.0000000000001880
pii: 00024382-202208000-00005
doi:
Substances chimiques
Carbon Dioxide
142M471B3J
Oxygen
S88TT14065
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
119-127Informations de copyright
Copyright © 2021 by the Shock Society.
Déclaration de conflit d'intérêts
JCM Richard receives a part time salary from Air Liquide Medical Systems (Antony, France). B. Badat and M. Rigollot are medical engineers employed by the society Air Liquide Medical Systems (Antony France). The other authors have no personal conflict of interest to report regarding to this experiment. The authors report no conflicts of interest.
Références
Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Lott C, Olasveengen T, Paal P, Pellis T, et al.: European resuscitation council guidelines 2021: adult advanced life support. Resuscitation 161:115–151, 2021.
Nolan JP, Maconochie I, Soar J, Olasveengen TM, Greif R, Wyckoff MH, Singletary EM, Aickin R, Berg KM, Mancini ME, et al.: Executive summary 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 156:A1–A22, 2020.
Cordioli RL, Lyazidi A, Rey N, Granier J-M, Savary D, Brochard L, Richard J-CM: Impact of ventilation strategies during chest compression. An experimental study with clinical observations. J Appl Physiol 120(2):196–203, 2016.
Cordioli RL, Brochard L, Suppan L, Lyazidi A, Templier F, Khoury A, Delisle S, Savary D, Richard J-C: How ventilation is delivered during cardiopulmonary resuscitation: an international survey. Respir Care 63(10):1293–1301, 2018.
Cordioli RL, Grieco DL, Charbonney E, Richard J-C, Savary D: New physiological insights in ventilation during cardiopulmonary resuscitation. Curr Opin Crit Care 25(1):37–44, 2019.
Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Neumar RW, O'Neil BJ, Paxton JH, Silvers SM, et al.: Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 132(18 Suppl 2):S444–S464, 2015.
Idris AH: Reassessing the need for ventilation during CPR. Ann Emerg Med 27(5):569–575, 1996.
Bernhard M, Hossfeld B, Kumle B, Becker TK, Böttiger B, Birkholz T: Don't forget to ventilate during cardiopulmonary resuscitation with mechanical chest compression devices. Eur J Anaesthesiol 33(8):553–556, 2016.
Fuest K, Dorfhuber F, Lorenz M, von Dincklage F, Mörgeli R, Kuhn KF, Jungwirth B, Kanz K-G, Blobner M, Schaller SJ: Comparison of volume-controlled, pressure-controlled, and chest compression-induced ventilation during cardiopulmonary resuscitation with an automated mechanical chest compression device: a randomized clinical pilot study. Resuscitation 166:85–92, 2021.
Vissers G, Soar J, Monsieurs KG: Ventilation rate in adults with a tracheal tube during cardiopulmonary resuscitation: a systematic review. Resuscitation 119:5–12, 2017.
Grieco DL, J Brochard L, Drouet A, Telias I, Delisle S, Bronchti G, Ricard C, Rigollot M, Badat B, Ouellet P, et al.: Intrathoracic airway closure impacts CO2 signal and delivered ventilation during cardiopulmonary resuscitation. Am J Respir Crit Care Med 199(6):728–737, 2019.
Saïssy JM, Boussignac G, Cheptel E, Rouvin B, Fontaine D, Bargues L, Levecque JP, Michel A, Brochard L: Efficacy of continuous insufflation of oxygen combined with active cardiac compression-decompression during out-of-hospital cardiorespiratory arrest. Anesthesiology 92(6):1523–1530, 2000.
Bertrand C, Hemery F, Carli P, Goldstein P, Espesson C, Rüttimann M, Macher JM, Raffy B, Fuster P, Dolveck F, et al.: Constant flow insufflation of oxygen as the sole mode of ventilation during out-of-hospital cardiac arrest. Intensive Care Med 32(6):843–851, 2006.
Boussignac G, Galia F, Roy H, Blanche M, Oudet J, Deslandes JC, Jaber S, Peschanski N: Comparative testing of a No-No Flow new ventilation device during experimental cardio pulmonary resuscitation on a lung-simulation system. Resuscitation 96(1):49, 2015.
Deakin CD, O'Neill JF, Tabor T: Does compression-only cardiopulmonary resuscitation generate adequate passive ventilation during cardiac arrest?Resuscitation 75(1):53–59, 2007.
Vygon: Vygon launches b-card, an innovative device that combines continuous chest compressions and dynamic oxygenation for CPR. Available at: https://www.vygon.com/wp-content/uploads/2016/09/160808-vygon-b-card-en-final.pdf , 2016. Accessed September 16, 2016.
Moore JC, Lamhaut L, Hutin A, Dodd KW, Robinson AE, Lick MC, Salverda BJ, Hinke MB, Labarere J, Debaty G, et al.: Evaluation of the Boussignac Cardiac arrest device (B-card) during cardiopulmonary resuscitation in an animal model. Resuscitation 119:81–88, 2017.
Nichol G, Leroux B, Wang H, Callaway CW, Sopko G, Weisfeldt M, Stiell I, Morrison LJ, Aufderheide TP, Cheskes S, et al.: Trial of continuous or interrupted chest compressions during CPR. N Engl J Med 373(23):2203–2214, 2015.
Fritz C, Kimmoun A, Vanhuyse F, Trifan BF, Orlowski S, Falanga A, Marie V, Groubatch F, Albuisson E, Tran N, et al.: High versus low blood-pressure target in experimental ischemic prolonged cardiac arrest treated with extra corporeal life support. Shock 47(6):759–764, 2017.
West JB: Respiratory Physiology: The Essentials 2012. 9 ed. Lippincott Williams & Wilkins; 2012, pp 24–33.
Wang C-H, Chang W-T, Huang C-H, Tsai M-S, Yu P-H, Wang A-Y, Chen N-C, Chen W-J: The effect of hyperoxia on survival following adult cardiac arrest: a systematic review and meta-analysis of observational studies. Resuscitation 85(9):1142–1148, 2014.
Douzinas EE, Patsouris E, Kypriades EM, Makris DJ, Andrianakis I, Korkolo-Poulou P, Boursinos V, Papalois A, Sotiropoulou C, Davaris P, et al.: Hypoxaemic reperfusion ameliorates the histopathological changes in the pig brain after a severe global cerebral ischaemic insult. Intensive Care Med 27(5):905–910, 2001.
Skrifvars MB: Towards interventional trials on the use of oxygen during and after cardiac arrest. Resuscitation 101:A3–4, 2016.
Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, et al.: European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post- resuscitation care. Intensive Care Med 47(4):369–421, 2021.
Schneider AG, Eastwood GM, Bellomo R, Bailey M, Lipcsey M, Pilcher D, Young P, Stow P, Santamaria J, Stachowski E, et al.: Arterial carbon dioxide tension and outcome in patients admitted to the intensive care unit after cardiac arrest. Resuscitation 84(7):927–934, 2013.
Eastwood GM, Schneider AG, Suzuki S, Peck L, Young H, Tanaka A, Mårtensson J, Warrillow S, McGuinness S, Parke R, et al.: A phase II multi-centre randomised controlled trial (the CCC trial). Resuscitation 104:83–90, 2016.
Vannucci RC, Towfighi J, Brucklacher RM, Vannucci SJ: Effect of extreme hypercapnia on hypoxic-ischemic brain damage in the immature rat. Pediatr Res 49(6):799–803, 2001.
Dyson A, Stidwill R, Taylor V, Singer M: The impact of inspired oxygen concentration on tissue oxygenation during progressive haemorrhage. Intensive Care Med 35(10):1783–1791, 2009.
van den Brule JMD, van der Hoeven JG, Hoedemaekers CWE: Cerebral perfusion and cerebral autoregulation after cardiac arrest. Biomed Res Int 2018:4143636, 2018.
Schnaubelt S, Sulzgruber P, Menger J, Skhirtladze-Dworschak K, Sterz F, Dworschak M: Regional cerebral oxygen saturation during cardiopulmonary resuscitation as a predictor of return of spontaneous circulation and favourable neurological outcome: a review of the current literature. Resuscitation 125:39–47, 2018.
Hodgkin BC, Lambrew CT, Lawrence FH, Angelakos ET: Effects of PEEP and of increased frequency of ventilation during CPR. Crit Care Med 8(3):123–126, 1980.
Voelckel WG, Lurie KG, Zielinski T, McKnite S, Plaisance P, Wenzel V, Lindner KH: The effects of positive end-expiratory pressure during active compression decompression cardiopulmonary resuscitation with the inspiratory threshold valve. Anesth Analg 92(4):967–974, 2001.
McCaul C, Kornecki A, Engelberts D, McNamara P, Kavanagh BP: Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine. Anesth Analg 109(4):1202–1208, 2009.
Charbonney E, Delisle S, Savary D, Bronchti G, Rigollot M, Drouet A, Badat B, Ouellet P, Gosselin P, Mercat A, et al.: A new physiological model for studying the effect of chest compression and ventilation during cardiopulmonary resuscitation: the Thiel cadaver. Resuscitation 125:135–142, 2018.