Chest compression synchronized ventilation versus chest compression asynchronized ventilation in asphyxiated...

Current pediatric guidelines recommend chest compressions with asynchronized ventilation (CCaV) after an advanced airway has been secured. An alternative approach might be chest compression synchronized ventilation (CCSV). We hypothesized that CCSV, compared to CCaV, will decrease time to return of spontaneous circulation (ROSC) in asphyxiated pediatric piglets with bradycardic cardiac arrest.

Twenty pediatric pigs (n = 10/group, 3-4 weeks old) were anesthetized, intubated, and instrumented, followed by asphyxia and bradycardic cardiac arrest. Piglets were randomized to CCSV or CCaV. During CCSV, piglets received 100-120 compressions/min with a ventilator-synchronized inflation delivered during every compression (CCSV Mode, MEDUMAT Standard² Ventilator, Weinmann Emergency Medical Technology, Hamburg, Germany). During CCaV, piglets received 100-120 compressions/min with asynchronous ventilations (20-30/min) delivered with a self-inflating bag. Compressions and ventilations were continued until ROSC.

The median (IQR) asphyxia time was not different between CCSV (391 (338-413)) s and CCaV (342 (283-385)) s (p = 0.151). Time to ROSC was not significantly different between groups, CCSV with 428 (344-526) s vs CCaV with 271 (172-454) s (p = 0.240). Rate of ROSC with CCSV was 6/10 and with CCaV was 6/10 (p = 1.000).

During cardiopulmonary resuscitation, the high ventilation rates delivered by CCSV did not improve outcomes in pediatric piglets compared to lower ventilation rates delivered by CCaV.

This is the first pediatric animal study to compare chest compression synchronized ventilation (CCSV) and chest compression asynchronous ventilation (CCaV) following asphyxial cardiac arrest. Time to and rates of return of spontaneous circulation (ROSC) were similar between CCSV and CCaV. Hemodynamic parameters before, during, and after resuscitation were comparable between CCSV and CCaV groups. Respiratory parameters differed, with higher ventilation rates and minute ventilation during CCSV without affecting gas exchange or outcomes. Markers of lung inflammation (IL-6, IL-8, TNF-α) were similar between CCSV and CCaV, indicating no added pulmonary injury with synchronized ventilation.