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Standardized Model of Ventricular Fibrillation and Advanced Cardiac Life Support in Swine
Published on: January 30, 2020
Injury characteristics and hemodynamics associated with guideline-compliant CPR in a pediatric porcine cardiac arrest
David D Salcido1, Allison C Koller1, Cornelia Genbrugge2
1University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Insights
Pediatric cardiopulmonary resuscitation (CPR) guidelines for chest compression depth lack evidence. Compressing to 1/3 anterior-posterior diameter (APd) caused more harm than 1.5 inches in swine, without improving resuscitation outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Cardiopulmonary Resuscitation Research
- Biomedical Engineering
Background:
- Current pediatric cardiopulmonary resuscitation (CPR) guidelines for chest compression depth are based on limited scientific evidence.
- The optimal depth for effective and safe pediatric CPR remains an area of active investigation.
Purpose of the Study:
- To compare the safety and efficacy of two recommended chest compression depths (1.5 inches vs. 1/3 anterior-posterior diameter) in a pediatric swine model of cardiac arrest.
- To evaluate CPR-related injuries and resuscitation outcomes associated with different compression depths.
Main Methods:
- A randomized laboratory study using a swine model of asphyxial cardiac arrest.
- Mechanical CPR was delivered at either 1.5 inches or 1/3 anterior-posterior diameter (APd).
- Primary outcomes included return of spontaneous circulation (ROSC), hemodynamic parameters, and CPR-related injury severity.
Main Results:
- The 1/3 APd compression group experienced significantly higher rates of rib fractures, sternal fractures, hemothorax, and airway blood compared to the 1.5-inch group.
- The study was terminated early for the 1/3 APd group due to overwhelming injury.
- Return of spontaneous circulation and hemodynamic measures were comparable between the two groups.
Conclusions:
- In a pediatric cardiac arrest model, chest compressions to 1/3 APd resulted in greater injury without improving resuscitation outcomes compared to 1.5-inch compressions.
- These findings suggest that the 1.5-inch compression depth may be safer in pediatric CPR.
- Further research is needed to refine pediatric CPR guidelines based on robust evidence.
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.
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