Continuous chest compressions during sustained inflations in a perinatal asphyxial cardiac arrest lamb model

Payam Vali, Praveen Chandrasekharan, Munmun Rawat, Sylvia Gugino, Carmon Koenigsknecht, Justin Helman, Bobby Mathew, Sara Berkelhamer, Jayasree Nair, Satyanarayana Lakshminrusimha

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: Continuous chest compressions are more effective during resuscitation in adults. Sustained inflation rapidly establishes functional residual capacity in fluid-filled lungs at birth. We sought to compare the hemodynamics and success in achieving return of spontaneous circulation in an asphyxial cardiac arrest lamb model with transitioning fetal circulation and fluid-filled lungs between subjects receiving continuous chest compressions during sustained inflation and those receiving conventional 3:1 compression-to-ventilation resuscitation. Design: Prospective, randomized, animal model study. Setting: An experimental laboratory. Subjects: Fourteen newborn term gestation lambs. Interventions: Lambs were randomized into two groups: 3:1 compression-to-ventilation (control) and continuous chest compressions during sustained inflation. The umbilical cord was occluded to induce asphyxia and asystole. The control group was resuscitated per NRP guidelines. In the sustained inflation + continuous chest compressions group, sustained inflation at 35 cm H2O was provided for 30 seconds with 1-second interruptions before another sustained inflation was provided. One hundred twenty chest compressions/min started after the initial sustained inflation. The first dose of IV epinephrine was given at 6 minutes if return of spontaneous circulation was not achieved and then every 3 minutes until return of spontaneous circulation or for a total of four doses. Measurement and Results: All lambs achieved return of spontaneous circulation in a comparable median time (interquartile range) of 390 seconds (225-405 s) and 345 seconds (204-465 s) in the sustained inflation + continuous chest compressions and control groups, respectively. Four of seven (sustained inflation + continuous chest compressions) and three of six (control) lambs required epinephrine to achieve return of spontaneous circulation. Diastolic blood pressures were lower in the sustained inflation + continuous chest compressions (4 ± 2 mm Hg) compared to the control group (7 ± 2 mm Hg), p < 0.05. Paco2, Pao2, and lactate were similar between the groups during the study period. Conclusion: In this perinatal cardiac arrest lamb model with transitioning fetal circulation and fluid-filled lungs, sustained inflation + continuous chest compressions is as effective as 3:1 compression-to-ventilation resuscitation in achieving return of spontaneous circulation. Half the lambs achieved return of spontaneous circulation without epinephrine. continuous chest compressions during sustained inflation reduced diastolic pressures but did not alter gas exchange or carotid blood flow compared to 3:1 compression-to-ventilation resuscitation.

Original languageEnglish (US)
Pages (from-to)e370-e377
JournalPediatric Critical Care Medicine
Volume18
Issue number8
DOIs
StatePublished - Aug 1 2017

Fingerprint

Economic Inflation
Heart Arrest
Thorax
Resuscitation
Ventilation
Epinephrine
Blood Pressure
Lung
Control Groups
Functional Residual Capacity
Umbilical Cord
Asphyxia
Lactic Acid
Animal Models
Gases
Hemodynamics
Parturition
Guidelines

Keywords

  • Chest compressions
  • Epinephrine
  • Newborn
  • Resuscitation
  • Sustained inflation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Continuous chest compressions during sustained inflations in a perinatal asphyxial cardiac arrest lamb model. / Vali, Payam; Chandrasekharan, Praveen; Rawat, Munmun; Gugino, Sylvia; Koenigsknecht, Carmon; Helman, Justin; Mathew, Bobby; Berkelhamer, Sara; Nair, Jayasree; Lakshminrusimha, Satyanarayana.

In: Pediatric Critical Care Medicine, Vol. 18, No. 8, 01.08.2017, p. e370-e377.

Research output: Contribution to journalArticle

Vali, P, Chandrasekharan, P, Rawat, M, Gugino, S, Koenigsknecht, C, Helman, J, Mathew, B, Berkelhamer, S, Nair, J & Lakshminrusimha, S 2017, 'Continuous chest compressions during sustained inflations in a perinatal asphyxial cardiac arrest lamb model', Pediatric Critical Care Medicine, vol. 18, no. 8, pp. e370-e377. https://doi.org/10.1097/PCC.0000000000001248
Vali, Payam ; Chandrasekharan, Praveen ; Rawat, Munmun ; Gugino, Sylvia ; Koenigsknecht, Carmon ; Helman, Justin ; Mathew, Bobby ; Berkelhamer, Sara ; Nair, Jayasree ; Lakshminrusimha, Satyanarayana. / Continuous chest compressions during sustained inflations in a perinatal asphyxial cardiac arrest lamb model. In: Pediatric Critical Care Medicine. 2017 ; Vol. 18, No. 8. pp. e370-e377.
@article{6299d80290b440e9a0bac9ec5372eb6f,
title = "Continuous chest compressions during sustained inflations in a perinatal asphyxial cardiac arrest lamb model",
abstract = "Objective: Continuous chest compressions are more effective during resuscitation in adults. Sustained inflation rapidly establishes functional residual capacity in fluid-filled lungs at birth. We sought to compare the hemodynamics and success in achieving return of spontaneous circulation in an asphyxial cardiac arrest lamb model with transitioning fetal circulation and fluid-filled lungs between subjects receiving continuous chest compressions during sustained inflation and those receiving conventional 3:1 compression-to-ventilation resuscitation. Design: Prospective, randomized, animal model study. Setting: An experimental laboratory. Subjects: Fourteen newborn term gestation lambs. Interventions: Lambs were randomized into two groups: 3:1 compression-to-ventilation (control) and continuous chest compressions during sustained inflation. The umbilical cord was occluded to induce asphyxia and asystole. The control group was resuscitated per NRP guidelines. In the sustained inflation + continuous chest compressions group, sustained inflation at 35 cm H2O was provided for 30 seconds with 1-second interruptions before another sustained inflation was provided. One hundred twenty chest compressions/min started after the initial sustained inflation. The first dose of IV epinephrine was given at 6 minutes if return of spontaneous circulation was not achieved and then every 3 minutes until return of spontaneous circulation or for a total of four doses. Measurement and Results: All lambs achieved return of spontaneous circulation in a comparable median time (interquartile range) of 390 seconds (225-405 s) and 345 seconds (204-465 s) in the sustained inflation + continuous chest compressions and control groups, respectively. Four of seven (sustained inflation + continuous chest compressions) and three of six (control) lambs required epinephrine to achieve return of spontaneous circulation. Diastolic blood pressures were lower in the sustained inflation + continuous chest compressions (4 ± 2 mm Hg) compared to the control group (7 ± 2 mm Hg), p < 0.05. Paco2, Pao2, and lactate were similar between the groups during the study period. Conclusion: In this perinatal cardiac arrest lamb model with transitioning fetal circulation and fluid-filled lungs, sustained inflation + continuous chest compressions is as effective as 3:1 compression-to-ventilation resuscitation in achieving return of spontaneous circulation. Half the lambs achieved return of spontaneous circulation without epinephrine. continuous chest compressions during sustained inflation reduced diastolic pressures but did not alter gas exchange or carotid blood flow compared to 3:1 compression-to-ventilation resuscitation.",
keywords = "Chest compressions, Epinephrine, Newborn, Resuscitation, Sustained inflation",
author = "Payam Vali and Praveen Chandrasekharan and Munmun Rawat and Sylvia Gugino and Carmon Koenigsknecht and Justin Helman and Bobby Mathew and Sara Berkelhamer and Jayasree Nair and Satyanarayana Lakshminrusimha",
year = "2017",
month = "8",
day = "1",
doi = "10.1097/PCC.0000000000001248",
language = "English (US)",
volume = "18",
pages = "e370--e377",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Continuous chest compressions during sustained inflations in a perinatal asphyxial cardiac arrest lamb model

AU - Vali, Payam

AU - Chandrasekharan, Praveen

AU - Rawat, Munmun

AU - Gugino, Sylvia

AU - Koenigsknecht, Carmon

AU - Helman, Justin

AU - Mathew, Bobby

AU - Berkelhamer, Sara

AU - Nair, Jayasree

AU - Lakshminrusimha, Satyanarayana

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Objective: Continuous chest compressions are more effective during resuscitation in adults. Sustained inflation rapidly establishes functional residual capacity in fluid-filled lungs at birth. We sought to compare the hemodynamics and success in achieving return of spontaneous circulation in an asphyxial cardiac arrest lamb model with transitioning fetal circulation and fluid-filled lungs between subjects receiving continuous chest compressions during sustained inflation and those receiving conventional 3:1 compression-to-ventilation resuscitation. Design: Prospective, randomized, animal model study. Setting: An experimental laboratory. Subjects: Fourteen newborn term gestation lambs. Interventions: Lambs were randomized into two groups: 3:1 compression-to-ventilation (control) and continuous chest compressions during sustained inflation. The umbilical cord was occluded to induce asphyxia and asystole. The control group was resuscitated per NRP guidelines. In the sustained inflation + continuous chest compressions group, sustained inflation at 35 cm H2O was provided for 30 seconds with 1-second interruptions before another sustained inflation was provided. One hundred twenty chest compressions/min started after the initial sustained inflation. The first dose of IV epinephrine was given at 6 minutes if return of spontaneous circulation was not achieved and then every 3 minutes until return of spontaneous circulation or for a total of four doses. Measurement and Results: All lambs achieved return of spontaneous circulation in a comparable median time (interquartile range) of 390 seconds (225-405 s) and 345 seconds (204-465 s) in the sustained inflation + continuous chest compressions and control groups, respectively. Four of seven (sustained inflation + continuous chest compressions) and three of six (control) lambs required epinephrine to achieve return of spontaneous circulation. Diastolic blood pressures were lower in the sustained inflation + continuous chest compressions (4 ± 2 mm Hg) compared to the control group (7 ± 2 mm Hg), p < 0.05. Paco2, Pao2, and lactate were similar between the groups during the study period. Conclusion: In this perinatal cardiac arrest lamb model with transitioning fetal circulation and fluid-filled lungs, sustained inflation + continuous chest compressions is as effective as 3:1 compression-to-ventilation resuscitation in achieving return of spontaneous circulation. Half the lambs achieved return of spontaneous circulation without epinephrine. continuous chest compressions during sustained inflation reduced diastolic pressures but did not alter gas exchange or carotid blood flow compared to 3:1 compression-to-ventilation resuscitation.

AB - Objective: Continuous chest compressions are more effective during resuscitation in adults. Sustained inflation rapidly establishes functional residual capacity in fluid-filled lungs at birth. We sought to compare the hemodynamics and success in achieving return of spontaneous circulation in an asphyxial cardiac arrest lamb model with transitioning fetal circulation and fluid-filled lungs between subjects receiving continuous chest compressions during sustained inflation and those receiving conventional 3:1 compression-to-ventilation resuscitation. Design: Prospective, randomized, animal model study. Setting: An experimental laboratory. Subjects: Fourteen newborn term gestation lambs. Interventions: Lambs were randomized into two groups: 3:1 compression-to-ventilation (control) and continuous chest compressions during sustained inflation. The umbilical cord was occluded to induce asphyxia and asystole. The control group was resuscitated per NRP guidelines. In the sustained inflation + continuous chest compressions group, sustained inflation at 35 cm H2O was provided for 30 seconds with 1-second interruptions before another sustained inflation was provided. One hundred twenty chest compressions/min started after the initial sustained inflation. The first dose of IV epinephrine was given at 6 minutes if return of spontaneous circulation was not achieved and then every 3 minutes until return of spontaneous circulation or for a total of four doses. Measurement and Results: All lambs achieved return of spontaneous circulation in a comparable median time (interquartile range) of 390 seconds (225-405 s) and 345 seconds (204-465 s) in the sustained inflation + continuous chest compressions and control groups, respectively. Four of seven (sustained inflation + continuous chest compressions) and three of six (control) lambs required epinephrine to achieve return of spontaneous circulation. Diastolic blood pressures were lower in the sustained inflation + continuous chest compressions (4 ± 2 mm Hg) compared to the control group (7 ± 2 mm Hg), p < 0.05. Paco2, Pao2, and lactate were similar between the groups during the study period. Conclusion: In this perinatal cardiac arrest lamb model with transitioning fetal circulation and fluid-filled lungs, sustained inflation + continuous chest compressions is as effective as 3:1 compression-to-ventilation resuscitation in achieving return of spontaneous circulation. Half the lambs achieved return of spontaneous circulation without epinephrine. continuous chest compressions during sustained inflation reduced diastolic pressures but did not alter gas exchange or carotid blood flow compared to 3:1 compression-to-ventilation resuscitation.

KW - Chest compressions

KW - Epinephrine

KW - Newborn

KW - Resuscitation

KW - Sustained inflation

UR - http://www.scopus.com/inward/record.url?scp=85021670043&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021670043&partnerID=8YFLogxK

U2 - 10.1097/PCC.0000000000001248

DO - 10.1097/PCC.0000000000001248

M3 - Article

C2 - 28661972

AN - SCOPUS:85021670043

VL - 18

SP - e370-e377

JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

SN - 1529-7535

IS - 8

ER -