Chest compressions superimposed with sustained inflations during cardiopulmonary resuscitation in asphyxiated
Chelsea M D Morin1,2, Po-Yin Cheung1,2, Tze-Fun Lee1,2
1Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada.
Insights
Chest compressions with sustained inflation (CC+SI) significantly reduced resuscitation time and increased return of spontaneous circulation (ROSC) in piglets. This advanced cardiopulmonary resuscitation technique shows promise for pediatric cardiac arrest.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiopulmonary Physiology
- Neonatal Resuscitation
Background:
- Current pediatric resuscitation guidelines recommend continuous chest compressions with asynchronized ventilation (CCaV).
- Previous research indicated that sustained inflation (SI) combined with continuous chest compressions (CC) reduces time to return of spontaneous circulation (ROSC) in piglets with asphyxia-induced cardiac arrest.
Purpose of the Study:
- To compare the efficacy of CC+SI versus CCaV in improving ROSC frequency and reducing resuscitation time in asphyxiated pediatric piglets.
- To evaluate the impact of CC+SI on hemodynamic and respiratory parameters during resuscitation.
Main Methods:
- Twenty-eight pediatric piglets underwent induced asphyxia and were randomized to receive either CC+SI or CCaV resuscitation (n=14/group).
- Continuous monitoring of heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, and respiratory parameters was performed throughout the experiment.
Main Results:
- Resuscitation duration was significantly shorter with CC+SI (208s) compared to CCaV (388s) (p=0.045).
- The rate of achieving ROSC was higher in the CC+SI group (12/14) versus the CCaV group (6/14) (p=0.046).
- Minute ventilation, end-tidal carbon dioxide, ventilation rate, and positive end-expiratory pressures were significantly improved with CC+SI.
Conclusions:
- CC+SI significantly improves resuscitation duration and increases the number of piglets achieving ROSC compared to CCaV.
- Improved minute ventilation is a key factor contributing to the enhanced outcomes observed with CC+SI.
- Further animal studies are warranted to explore the clinical application of CC+SI in pediatric resuscitation.
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:
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:
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:
CC + SI improves duration of resuscitation and increases number of piglets achieving ROSC secondary to improved minute ventilation.
Impact:
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.
