Myocardial perfusion and oxidative stress after 21% vs. 100% oxygen ventilation and uninterrupted chest compressions in severely asphyxiated piglets

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• 作者：Anne Lee Solevå ; g^a ; ^b ; ^c ; ^{a.l.solevag@medisin.uio.no" class="auth_mail" title="E-mail the corresponding author} ; Georg M. Schmö ; lzer^a ; ^b ; Megan O&rsquo ; Reilly^a ; ^b ; Min Lu^a ; ^b ; Tze-Fun Lee^a ; ^b ; Lisa K. Hornberger^b ; Britt Nakstad^c ; Po-Yin Cheung^a ; ^b
• 关键词：CC ; chest compressions ; CPR ; cardiopulmonary resuscitation ; CCaV ; continuous CC and asynchronous ventilation ; C ; V ; chest compression to ventilation ; ILCOR ; International Liaison Committee on Resuscitation ; ROSC ; return of spontaneous circulation ; SpO2 ; oxygen saturation ; HR ; heart rate ; paCO2 ; partial arterial CO2 ; ETCO2 ; end-tidal CO2 ; VT ; tidal volume ; CO ; cardiac output ; LVOT ; left ventricular outflow tract ; PW ; pulsed wave ; SV ; stroke volume ; CPAP ; continuous positive airway pressure ; PEEP
• 刊名：Resuscitation
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：106
• 期：Complete
• 页码：7-13
• 全文大小：913 K

文摘

Despite the minimal evidence, neonatal resuscitation guidelines recommend using 100% oxygen when chest compressions (CC) are needed. Uninterrupted CC in adult cardiopulmonary resuscitation (CPR) may improve CPR hemodynamics. We aimed to examine 21% oxygen (air) vs. 100% oxygen in 3:1 CC:ventilation (C:V) CPR or continuous CC with asynchronous ventilation (CCaV) in asphyxiated newborn piglets following cardiac arrest.

Methods

Piglets (1–3 days old) were progressively asphyxiated until cardiac arrest and randomized to 4 experimental groups (n = 8 each): air and 3:1 C:V CPR, 100% oxygen and 3:1 C:V CPR, air and CCaV, or 100% oxygen and CCaV. Time to return of spontaneous circulation (ROSC), mortality, and clinical and biochemical parameters were compared between groups. We used echocardiography to measure left ventricular (LV) stroke volume at baseline, at 30 min and 4 h after ROSC. Left common carotid artery blood pressure was measured continuously.

Results

Time to ROSC (heart rate ≥100 min⁻¹) ranged from 75 to 592 s and mortality 50–75%, with no differences between groups. Resuscitation with air was associated with higher LV stroke volume after ROSC and less myocardial oxidative stress compared to 100% oxygen groups. CCaV was associated with lower mean arterial blood pressure after ROSC and higher myocardial lactate than those of 3:1 C:V CPR.

Conclusion

In neonatal asphyxia-induced cardiac arrest, using air during CC may reduce myocardial oxidative stress and improve cardiac function compared to 100% oxygen. Although overall recovery may be similar, CCaV may impair tissue perfusion compared to 3:1 C:V CPR.