Chest compressions superimposed with sustained inflations during cardiopulmonary resuscitation in asphyxiated pediatric piglets.

Journal

Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714

Informations de publication

Date de publication:
17 Mar 2023
Historique:
received: 11 08 2022
accepted: 27 02 2023
revised: 13 02 2023
entrez: 18 3 2023
pubmed: 19 3 2023
medline: 19 3 2023
Statut: aheadofprint

Résumé

Pediatric resuscitation guidelines recommend continuous chest compression with asynchronized ventilation (CCaV) during cardiopulmonary resuscitation. We recently described that providing a constant high distending pressure, or sustained inflation (SI) while performing continuous chest compressions (CC = CC + SI) reduces time to return of spontaneous circulation (ROSC) in neonatal and pediatric piglets with asphyxia-induced cardiac arrest. To determine if CC + SI compared to CCaV will improve frequency of achieving ROSC and reduce time to ROSC in asphyxiated pediatric piglets. Twenty-eight pediatric piglets (21-24 days old) were anesthetized and asphyxiated by clamping the endotracheal tube. Piglets were randomized to CC + SI or CCaV for resuscitation (n = 14/group). Heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. The mean(SD) duration of resuscitation was significantly reduced with CC + SI compared to CCaV with 208(190) vs. 388(258)s, p = 0.045, respectively. The number of piglets achieving ROSC with CC + SI and CCaV were 12/14 vs. 6/14, p = 0.046. Minute ventilation, end-tidal carbon dioxide, ventilation rate, and positive end expiratory pressures were also significantly improved with CC + SI. CC + SI improves duration of resuscitation and increases number of piglets achieving ROSC secondary to improved minute ventilation. Chest compressions superimposed with sustained inflation resulted in shorter duration of resuscitation Chest compressions superimposed with sustained inflation resulted in higher number of piglets achieving return of spontaneous circulation Further animal studies are needed to examine chest compressions superimposed with sustained inflation.

Sections du résumé

BACKGROUND BACKGROUND
Pediatric resuscitation guidelines recommend continuous chest compression with asynchronized ventilation (CCaV) during cardiopulmonary resuscitation. We recently described that providing a constant high distending pressure, or sustained inflation (SI) while performing continuous chest compressions (CC = CC + SI) reduces time to return of spontaneous circulation (ROSC) in neonatal and pediatric piglets with asphyxia-induced cardiac arrest.
METHODS METHODS
To determine if CC + SI compared to CCaV will improve frequency of achieving ROSC and reduce time to ROSC in asphyxiated pediatric piglets. Twenty-eight pediatric piglets (21-24 days old) were anesthetized and asphyxiated by clamping the endotracheal tube. Piglets were randomized to CC + SI or CCaV for resuscitation (n = 14/group). Heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment.
RESULTS RESULTS
The mean(SD) duration of resuscitation was significantly reduced with CC + SI compared to CCaV with 208(190) vs. 388(258)s, p = 0.045, respectively. The number of piglets achieving ROSC with CC + SI and CCaV were 12/14 vs. 6/14, p = 0.046. Minute ventilation, end-tidal carbon dioxide, ventilation rate, and positive end expiratory pressures were also significantly improved with CC + SI.
CONCLUSIONS CONCLUSIONS
CC + SI improves duration of resuscitation and increases number of piglets achieving ROSC secondary to improved minute ventilation.
IMPACT CONCLUSIONS
Chest compressions superimposed with sustained inflation resulted in shorter duration of resuscitation Chest compressions superimposed with sustained inflation resulted in higher number of piglets achieving return of spontaneous circulation Further animal studies are needed to examine chest compressions superimposed with sustained inflation.

Identifiants

DOI: 10.1038/s41390-023-02563-9 PMID: 36932182
pubmed: 36932182
doi: 10.1038/s41390-023-02563-9
pii: 10.1038/s41390-023-02563-9
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2023. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.

Références

Topjian, A. A. et al. Part 4: Pediatric basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 142, https://doi.org/10.1161/CIR.0000000000000901 (2020).
Soar, J. et al. 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations: Summary from the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 140, https://doi.org/10.1161/CIR.0000000000000734 (2019)
Kitamura, T. et al. Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. Lancet 375, 8 (2010).
Sutton, R. M. et al. Ventilation rates and pediatric in-hospital cardiac arrest survival outcomes*. Crit. Care Med. 47, 1627–1636 (2019).
doi: 10.1097/CCM.0000000000003898 pubmed: 31369424 pmcid: 7898415
Schmölzer G. M. et al. Sustained inflation during chest compression: a new technique of pediatric cardiopulmonary resuscitation that improves recovery and survival in a pediatric porcine model. J. Am. Heart Assoc. 10, https://doi.org/10.1161/JAHA.120.019136 (2021).
Schmölzer, G. M. et al. Cardiopulmonary resuscitation with chest compressions during sustained inflations: a new technique of neonatal resuscitation that improves recovery and survival in a neonatal porcine model. Circulation 128, 2495–2503 (2013).
doi: 10.1161/CIRCULATIONAHA.113.002289 pubmed: 24088527
Schmölzer, G. M. Chest compressions during sustained inflation during cardiopulmonary resuscitation in newborn infants translating evidence from animal studies to the bedside. JACC Basic Transl. Sci. 4, 116–121 (2019).
doi: 10.1016/j.jacbts.2018.12.004 pubmed: 30847426 pmcid: 6390679
Li, E. S. et al. 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. Neonatology 112, 337–346 (2017).
doi: 10.1159/000477998 pubmed: 28768280
Li, E. S. et al. Return of spontaneous circulation is not affected by different chest compression rates superimposed with sustained inflations during cardiopulmonary resuscitation in newborn piglets. PLoS ONE 11, e0157249 (2016).
doi: 10.1371/journal.pone.0157249 pubmed: 27304210 pmcid: 4909206
Mustofa, J. et al. Effects of different durations of sustained inflation during cardiopulmonary resuscitation on return of spontaneous circulation and hemodynamic recovery in severely asphyxiated piglets. Resuscitation 129, 82–89 (2018).
doi: 10.1016/j.resuscitation.2018.06.013 pubmed: 29928955
Schmölzer, G. M., O. Reilly, M., Fray, C., van Os, S. & Cheung, P. Y. Chest compression during sustained inflation versus 3:1 chest compression:ventilation ratio during neonatal cardiopulmonary resuscitation: a randomised feasibility trial. Arch. Dis. Child Fetal Neonatal Ed. 103, F455–F460 (2018).
doi: 10.1136/archdischild-2017-313037 pubmed: 28988159
Xanthos, T. et al. Baseline hemodynamics in anesthetized landrace–large white swine: reference values for research in cardiac arrest and cardiopulmonary resuscitation models. J. Am. Assoc. Lab. Anim. Sci. 46, 5 (2007).
Kilkenny C., Browne W., Cuthill I., Emerson M., & Aktman D. Improving bioscience research reporting: The ARRIVE Guidelines for Reporting Animal Research. PLOS Biol. 8, e1000412 (2010)
van Os, S. et al. Exhaled carbon dioxide can be used to guide respiratory support in the delivery room. Acta Paediatr. 103, 796–806 (2014).
doi: 10.1111/apa.12650 pubmed: 24698203
Baik, N. et al. Reference ranges for cerebral tissue oxygen saturation index in term neonates during immediate neonatal transition after birth. Neonatology 108, 283–286 (2015).
doi: 10.1159/000438450 pubmed: 26330229
Wollborn, J. et al. Standardized model of porcine resuscitation using a custom-made resuscitation board results in optimal hemodynamic management. Am. J. Emerg. Med. 36, 1738–1744 (2018).
doi: 10.1016/j.ajem.2018.01.059 pubmed: 29395757
Okubo, M., Chan, H. K., Callaway, C. W., Mann, N. C. & Wang, H. E. Characteristics of paediatric out-of-hospital cardiac arrest in the United States. Resuscitation 153, 227–233 (2020).
doi: 10.1016/j.resuscitation.2020.04.023 pubmed: 32348794
Jayaram, N., McNally, B., Tang, F. & Chan, P. S. Survival after out‐of‐hospital cardiac arrest in children. J. Am. Heart Assoc. 4, e002122 (2015).
doi: 10.1161/JAHA.115.002122 pubmed: 26450118 pmcid: 4845116
Sutton, R. M. et al. Effect of physiologic point-of-care cardiopulmonary resuscitation training on survival with favorable neurologic outcome in cardiac arrest in pediatric icus: a randomized clinical trial. JAMA 327, 934 (2022).
doi: 10.1001/jama.2022.1738 pubmed: 35258533 pmcid: 8905390
Manrique, G. et al. Comparison between synchronized and non-synchronized ventilation and between guided and non-guided chest compressions during resuscitation in a pediatric animal model after asphyxial cardiac arrest. PLoS ONE 14, e0219660 (2019).
doi: 10.1371/journal.pone.0219660 pubmed: 31318890 pmcid: 6638932
Sutton, R. M. et al. Hemodynamic-directed cardiopulmonary resuscitation during in-hospital cardiac arrest. Resuscitation 85, 983–986 (2014).
doi: 10.1016/j.resuscitation.2014.04.015 pubmed: 24783998 pmcid: 4087068
Lautz, A. J. et al. Hemodynamic-directed cardiopulmonary resuscitation improves neurologic outcomes and mitochondrial function in the heart and brain. Crit. Care Med. 47, e241–e249 (2019).
doi: 10.1097/CCM.0000000000003620 pubmed: 30779720 pmcid: 6561502
O’Brien, C. E. et al. Use of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swine. Resusc. Plus 8, 100174 (2021).
doi: 10.1016/j.resplu.2021.100174 pubmed: 34820656 pmcid: 8600153
Morgan, R. W. et al. A hemodynamic-directed approach to pediatric cardiopulmonary resuscitation (HD-CPR) improves survival. Resuscitation 111, 41–47 (2017).
doi: 10.1016/j.resuscitation.2016.11.018 pubmed: 27923692
Kern, K. B., Ewy, G. A., Voorhees, W. D., Babbs, C. F. & Tacker, W. A. Myocardial perfusion pressure: A predictor of 24-hour survival during prolonged cardiac arrest in dogs. Resuscitation 16, 241–250 (1988).
doi: 10.1016/0300-9572(88)90111-6 pubmed: 2849790
Halperin, H. R. et al. Determinants of blood flow to vital organs during cardiopulmonary resuscitation in dogs. Circulation 73, 539–550 (1986).
doi: 10.1161/01.CIR.73.3.539 pubmed: 3948359
Berg, R. A. et al. Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. Circulation 104, 2465–2470 (2001).
doi: 10.1161/hc4501.098926 pubmed: 11705826
Ewy, G. A. et al. Improved neurological outcome with continuous chest compressions compared with 30:2 compressions-to-ventilations cardiopulmonary resuscitation in a realistic swine model of out-of-hospital cardiac arrest. Circulation 116, 2525–2530 (2007).
doi: 10.1161/CIRCULATIONAHA.107.711820 pubmed: 17998457
Pearson, J. W. Influence of peripheral vascular tone on cardiac resuscitation. Anesth. Analg. 44, 746 (1965).
doi: 10.1213/00000539-196511000-00010 pubmed: 5891904
Berg, R. A. et al. Association between diastolic blood pressure during pediatric in-hospital cardiopulmonary resuscitation and survival. Circulation 137, 1784–1795 (2018).
doi: 10.1161/CIRCULATIONAHA.117.032270 pubmed: 29279413
Rudikoff, M. T., Freund P., & Weisfeldt M. L. Mechanisms of blood flow during cardiopulmonary resuscitation. Circulation 61, 8 (1980).
Chandra, N., Rudikoff, M. & Weisfeldt, M. L. Simultaneous chest compression and ventilation at high airway pressure during cardiopulmonary resuscitation. Lancet 26, 175–178 (1980).
doi: 10.1016/S0140-6736(80)90662-5
Berkowitz, I. D. et al. Blood flow during cardiopulmonary resuscitation with simultaneous compression and ventilation in infant pigs. Pediatr. Res. 26, 558–559 (1989).
doi: 10.1203/00006450-198912000-00006 pubmed: 2602034
Aufderheide, T. P. et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation 109, 1960–1965 (2004).
doi: 10.1161/01.CIR.0000126594.79136.61 pubmed: 15066941
de Caen, A. R. et al. Part 12: pediatric advanced life support: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 132, S525–S542 (2015).
McInnes, A. D. et al. The first quantitative report of ventilation rate during in-hospital resuscitation of older children and adolescents. Resuscitation 82, 1025–1029 (2011).
doi: 10.1016/j.resuscitation.2011.03.020 pubmed: 21497007 pmcid: 3703745
Li, E. S., Cheung, P. Y., O’Reilly, M. & Schmölzer, G. M. Change in tidal volume during cardiopulmonary resuscitation in newborn piglets. Arch. Dis. Child Fetal Neonatal Ed. 100, F530–F533 (2015).
doi: 10.1136/archdischild-2015-308363 pubmed: 26139543
Shim, G. H. et al. Effects of sustained inflation pressure during neonatal cardiopulmonary resuscitation of asphyxiated piglets. PLoS ONE 15, e0228693 (2020).
doi: 10.1371/journal.pone.0228693 pubmed: 32574159 pmcid: 7310834
Berg, R. A. et al. End-tidal carbon dioxide during pediatric in-hospital cardiopulmonary resuscitation. Resuscitation 133, 173–179 (2018).
doi: 10.1016/j.resuscitation.2018.08.013 pubmed: 30118812 pmcid: 6258346
Hamrick, J. T. et al. End-tidal CO2–guided chest compression delivery improves survival in a neonatal asphyxial cardiac arrest model*. Pediatr. Crit. Care Med. 18, e575–e584 (2017).
doi: 10.1097/PCC.0000000000001299 pubmed: 28817508 pmcid: 5669831
Nicoll, J. et al. Effect of cardiac output changes on exhaled carbon dioxide in newborn piglets. Resuscitation 84, 1439–1442 (2013).
doi: 10.1016/j.resuscitation.2013.05.004 pubmed: 23685103

Auteurs

Chelsea M D Morin (CMD)

Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada.
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Po-Yin Cheung (PY)

Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada.
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Tze-Fun Lee (TF)

Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada.
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Megan O'Reilly (M)

Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada.
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Georg M Schmölzer (GM)

Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada. georg.schmoelzer@me.com.
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. georg.schmoelzer@me.com.

Classifications MeSH