Asynchronous ventilation at 120 compared with 90 or 100 compressions per minute improves haemodynamic recovery in asphyxiated newborn piglets.

Abstract

OBJECTIVE:

To determine whether different chest compression (CC) rates during continuous CC with asynchronous ventilations (CCaV) reduce time to return of spontaneous circulation (ROSC) and improved haemodynamic recovery in piglets aged 24-72 hours with asphyxia-induced asystole.

METHODS:

Thirty piglets (aged 24-72 hours) were anaesthetised, intubated, instrumented and exposed to 30 min normocapnic hypoxia followed by asphyxia. Piglets were randomised into four groups: CCaV with CC rate of 90 (CCaV+90, n=8), 100 (CCaV+100, n=8) or 120 compressions per minute (CCaV+120, n=8), and a sham-operated group (n=6). Cardiac function, carotid blood flow, cerebral and renal oxygenation and respiratory parameters were continuously recorded. Cerebral cortical tissue was harvested and assayed for inflammatory and injury markers.

RESULTS:

All three intervention groups had a similar number of piglets achieving ROSC (6/8, 5/8 and 5/8 for CCaV+120, CCaV+100 and CCaV+90, respectively) and mean ROSC time (120, 90 and 90 s for CCaV+120, CCaV+100 and CCaV+90, respectively). The haemodynamic recovery (indicated by carotid flow, cerebral and renal perfusion) was similar between CCaV+120 and sham by the end of experiment. In comparison, CCaV+90 and CCaV+100 had significantly reduced haemodynamic recovery compared with sham operated (p≤0.05). Inflammatory (interleukin [IL]-6 and IL-1β) and injury markers (lactate) were significantly higher in the frontoparietal cortex of CCaV+90 and CCaV+100 compared with sham, whereas brain injury markers were similar between CCaV+120 and sham.

CONCLUSIONS:

Although there was no difference between the groups in achieving ROSC, the haemodynamic recovery of CCaV+120 was significantly improved compared with CCaV+90 and CCaV+100, which were also associated with higher cerebral inflammatory and brain injury markers.

• Authors: Sparsh Patel, Po-Yin Cheung, Tze-Fun Lee, Matteo P Pasquin, Min Lu, Megan O'Reilly, Georg M Schmölzer
• Journal: Archives of disease in childhood. Fetal and neonatal edition (Arch Dis Child Fetal Neonatal Ed) Vol. 105 Issue 4 Pg. 357-363 (Jul 2020) ISSN: 1468-2052 [Electronic] England
• PMID: 31123054 (Publication Type: Journal Article)
• Copyright: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Animals
• Animals, Newborn
• Asphyxia Neonatorum (physiopathology, therapy)
• Cardiopulmonary Resuscitation (methods)
• Disease Models, Animal
• Heart Arrest (physiopathology, therapy)
• Hemodynamics (physiology)
• Humans
• Infant, Newborn
• Swine
• Ventilation (methods)