Abstract 11968: Uninterrupted Chest Compressions does not Improve Hemodynamics During and After Cardiopulmonary Resuscitation in Asphyxiated Newborn Pigs
Introduction: Since asphyxia is the most common cause of a need for newborn cardiopulmonary resuscitation (CPR) the primary focus of CPR should be effective ventilation. Any intervention that interferes with ventilation should be introduced with caution. Thus, in newborn CPR it is recommended that chest compressions (CC) and ventilation be synchronized with a pause after every 3rd CC to deliver one effective ventilation, i.e. a CC to ventilation (C:V) ratio of 3:1. However, this recommendation is based on physiological plausibility, not scientific evidence. In adult CPR uninterrupted CC has been shown to improve hemodynamics including coronary perfusion pressure (CPP) and outcomes.
Hypothesis: In a newborn piglet model, we hypothesized that continuous CC and asynchronous ventilation (CCaV) would improve CPR hemodynamics and time to return of spontaneous circulation (ROSC) vs. 3:1 C:V CPR.
Methods: Thirty-two intubated piglets (1-3d old) were instrumented with a catheter in the left common carotid artery, asphyxiated until cardiac arrest and randomized to 3:1 C:V CPR or CCaV (n=16 in each group). In both groups, manual CC were performed and a metronome was used to help achieve 120 events (90 CC and 30 assisted ventilations)min-1. CPR characteristics and time to ROSC were compared between groups with the Mann-Whitney U test. Lactate was determined from homogenized left ventricle (LV) tissue collected 4 h after ROSC.
Results: At cardiac arrest, median (IQR) arterial pH was 6.6 (6.5-6.9), paCO2 78 (48-97) mmHg and lactate 18 (15-19) mmol/L with no differences between groups. Characteristics of CPR and post-CPR recovery are presented in Table 1.
Conclusions: Despite a modestly higher number of CCmin-1 CCaV did not improve DBP, a proxy for CPP during CPR, or ROSC. Mean arterial blood pressure after ROSC was slightly lower and LV lactate higher following CCaV vs. 3:1 C:V CPR. The results confirm the assumption that extrapolating evidence from adults to newborns is inappropriate.
- Cardiac arrest
- Cardiopulmonary resuscitation
- Chest compression
- Return of spontaneous circulation (ROSC)
Author Disclosures: A. Solevåg: None. G.M. Schmölzer: None. M. O’Reilly: None. M. Lu: None. T. Lee: None. E. Fortin-Pellerin?: None. L. Hornberger: None. P. Cheung: None.
- © 2015 by American Heart Association, Inc.