Journal Article

USING DIFFERENT CHEST COMPRESSIONS AND VENTILATION RATIOS (2:1, 3:1, 4:1) DURING NEONATAL ASPHYXIA IN A PORCINE MODEL OF NEONATAL RESUSCITATION – A RANDOMIZED CONTROLLED ANIMAL TRIAL

Matteo Pasquin, Po-Yin Cheung, Michael Wagner, Tze-Fun Lee, Megan O’Reilly and Georg Schmolzer

in Paediatrics & Child Health

Published on behalf of Canadian Paediatric Society

Volume 23, issue suppl_1 Published in print May 2018 | ISSN: 1205-7088
Published online May 2018 | e-ISSN: 1918-1485 | DOI: https://dx.doi.org/10.1093/pch/pxy054.054
USING DIFFERENT CHEST COMPRESSIONS AND VENTILATION RATIOS (2:1, 3:1, 4:1) DURING NEONATAL ASPHYXIA IN A PORCINE MODEL OF NEONATAL RESUSCITATION – A RANDOMIZED CONTROLLED ANIMAL TRIAL

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  • Neonatology
  • Primary Care
  • Child and Adolescent Psychiatry
  • Clinical Child and Adolescent Psychology
  • Developmental Psychology

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Abstract

BACKGROUND

The rationale for a compression to ventilation ratio of 3:1 in neonates with primary hypoxic, hypercapnic cardiac arrest is to emphasize the importance of ventilation; however, there are no published studies testing this approach against alternative methods.

OBJECTIVES

To evaluate if using a 2:1 C:V ratio or a 4:1 C:V ratio will improve ROSC compared to using a 3:1 C:V ratio.

DESIGN/METHODS

Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 40-min normocapnic hypoxia followed by asphyxia. Asphyxia was achieved by clamping the endotracheal tube until the piglet had asystole; at that time CPR was initiated. Piglets were then randomized into 3 groups: 2:1 C:V ratio (n=8), 3:1 ratio (n=8), 4:1 C:V ratio (n=8), or a sham operated group. A two-step randomization was used to reduce selection bias. After surgical instrumentation and stabilization, a sequentially numbered, sealed brown envelope containing the allocation “sham” or “intervention” was opened (step one). The sham-operated group had the same surgical protocol, stabilization, and equivalent experimental periods without hypoxia and asphyxia. Only piglets randomized to “intervention” underwent hypoxia and asphyxia. Once the criteria for CPR were met, a second envelope containing the allocations “2:1”,“3:1”,or “4:1”, was opened (step two). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment.

RESULTS

The median (IQR) duration of asphyxia was similar between the groups with 318 (194–576)sec, 255 (226–334)sec, 233 (169–395)sec for 2:1, 3:1, 4:1 C:V, respectively (p=0.68; oneway ANOVA with Bonferroni). The median (IQR) time to ROSC was also similar between groups 127 (82–210)sec, 96 (88–126)sec, 119 (83–256)sec for 2:1, 3:1, 4:1 C:V, respectively (p=0.67; oneway ANOVA with Bonferroni). Overall, 8/8 in the 2:1 C:V ratio group, 7/8 in the 3:1 C:V ratio group, and 7/8 in the 4:1 C:V ratio group survived.

CONCLUSION

There was no significant difference in time to ROSC for either chest compression technique during cardiopulmonary resuscitation in a porcine model of neonatal asphyxia.

Journal Article.  0 words. 

Subjects: Neonatology ; Primary Care ; Child and Adolescent Psychiatry ; Clinical Child and Adolescent Psychology ; Developmental Psychology

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