Injury characteristics and hemodynamics associated with guideline-compliant CPR in a pediatric porcine cardiac arrest model.

Abstract

BACKGROUND:

Guidelines for depth of chest compressions in pediatric cardiopulmonary resuscitation (CPR) are based on sparse evidence.

OBJECTIVE:

We sought to evaluate the performance of the two most widely recommended chest compression depth levels for pediatric CPR (1.5 in. and 1/3 the anterior-posterior diameter- APd) in a controlled swine model of asphyxial cardiac arrest.

METHODS:

We executed a 2-group, randomized laboratory study with an adaptive design allowing early termination for overwhelming injury or benefit. Forty mixed-breed domestic swine (mean weight = 26 kg) were sedated, anesthetized and paralyzed along with endotracheal intubation and mechanical ventilation. Asphyxial cardiac arrest was induced with fentanyl overdose. Animals were untreated for 9 min followed by mechanical CPR with a target depth of 1.5 in. or 1/3 the APd. Advanced life support drugs were administered IV after 4 min of basic resuscitation followed by defibrillation at 14 min. The primary outcomes were return of spontaneous circulation (ROSC), hemodynamics and CPR-related injury severity.

RESULTS:

Enrollment in the 1/3 APd group was stopped early due to overwhelming differences in injury. Twenty-three animals were assigned to the 1.5 in. group and 15 assigned to the 1/3 APd group, per an adaptive group design. The 1/3 APd group had increased frequency of rib fracture (6.7 vs 1.7, p < 0.001) and higher proportions of several anatomic injury markers than the 1.5 in. group, including sternal fracture, hemothorax and blood in the endotracheal tube (p < 0.001). ROSC and hemodynamic measures were similar between groups.

CONCLUSION:

In this pediatric model of cardiac arrest, chest compressions to 1/3APd were more harmful without a concurrent benefit for resuscitation outcomes compared to the 1.5 in. compression group.

• Authors: David D Salcido, Allison C Koller, Cornelia Genbrugge, Ericka L Fink, Robert A Berg, James J Menegazzi
• Journal: The American journal of emergency medicine (Am J Emerg Med) Vol. 51 Pg. 176-183 (Jan 2022) ISSN: 1532-8171 [Electronic] United States
• PMID: 34763236 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Topics

• Animals
• Asphyxia (complications)
• Cardiopulmonary Resuscitation (adverse effects, methods)
• Female
• Heart Arrest (etiology, therapy)
• Hemodynamics
• Hemothorax (etiology)
• Intubation, Intratracheal
• Male
• Models, Animal
• Random Allocation
• Respiration, Artificial (methods)
• Rib Fractures (etiology)
• Swine
• Thoracic Injuries (etiology)