Oxygenation and Hemodynamics during Chest Compressions in a Lamb Model of Perinatal Asphyxia Induced Cardiac Arrest
Oxygenation and Hemodynamics during Chest Compressions in a Lamb Model of Perinatal Asphyxia Induced Cardiac Arrest
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DOI：
10.3390/children6040052
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发表时间：
2019-04-01
期刊：
影响因子：
2.4
通讯作者：
Lakshminrusimha, Satyan
中科院分区：
文献类型：
--
作者：
Rawat, Munmun;Chandrasekharan, Praveen;Lakshminrusimha, Satyan
目前的指南建议在需要胸部按压（CC）的新生儿复苏时使用100% O-2。在出生后模型中进行了比较21%和100% O-2的研究，并没有显示自发性循环恢复（ROSC）的发生率或时间上的差异。本研究的目的是评估脐带闭塞致围产期窒息性骤停的绵羊模型在CC期间的全身氧合和向大脑的氧输送。22只羔羊脐带闭塞致无脉性心脏骤停。心跳停止5分钟后，按照新生儿复苏计划（NRP）指南，用21%的O-2对羔羊进行复苏。在CC发病时，激发O-2增加到100% O-2 （n = 25）或继续增加到21% （n = 9）。羔羊在ROSC后通气30分钟，逐渐滴定FiO(2)以达到85-95%的生产SpO(2)。所有羔羊均达到ROSC。CC时PaO2为21.6 +/- 1.6 mm Hg (21%)， PaO2为23.9 +/- 6.8 mm Hg (100%) （p = 0.16）。与胎儿基线水平（27 +/- 9 mL/kg/min）相比，CC期间颈动脉流量显著降低（21%组为1.2 +/- 1.6 mL/kg/min， 100%供氧组为3.2 +/- 3.4 mL/kg/min）。21%组脑供氧量为0.05 +/- 0.06 mL/kg/min， 100%组为0.11 +/- 0.09 mL/kg/min，显著低于胎儿水平（2.1 +/- 0.3 mL/kg/min）。在ROSC后立即，100% O-2通气的羔羊PaO2和肺流量较高。我们得出结论，在心脏骤停的胸外按压期间，颈动脉血流量、全身PaO2和脑供氧量非常低，与复苏期间21%或100%吸氧无关。
The current guidelines recommend the use of 100% O-2 during resuscitation of a neonate requiring chest compressions (CC). Studies comparing 21% and 100% O-2 during CC were conducted in postnatal models and have not shown a difference in incidence or timing of return of spontaneous circulation (ROSC). The objective of this study is to evaluate systemic oxygenation and oxygen delivery to the brain during CC in an ovine model of perinatal asphyxial arrest induced by umbilical cord occlusion. Pulseless cardiac arrest was induced by umbilical cord occlusion in 22 lambs. After 5 min of asystole, lambs were resuscitated with 21% O-2 as per Neonatal Resuscitation Program (NRP) guidelines. At the onset of CC, inspired O-2 was either increased to 100% O-2 (n = 25) or continued at 21% (n = 9). Lambs were ventilated for 30 min post ROSC and FiO(2) was gradually titrated to achieve preductal SpO(2) of 85-95%. All lambs achieved ROSC. During CC, PaO2 was 21.6 +/- 1.6 mm Hg with 21% and 23.9 +/- 6.8 mm Hg with 100% O-2 (p = 0.16). Carotid flow was significantly lower during CC (1.2 +/- 1.6 mL/kg/min in 21% and 3.2 +/- 3.4 mL/kg/min in 100% oxygen) compared to baseline fetal levels (27 +/- 9 mL/kg/min). Oxygen delivery to the brain was 0.05 +/- 0.06 mL/kg/min in the 21% group and 0.11 +/- 0.09 mL/kg/min in the 100% group and was significantly lower than fetal levels (2.1 +/- 0.3 mL/kg/min). Immediately after ROSC, lambs ventilated with 100% O-2 had higher PaO2 and pulmonary flow. It was concluded that carotid blood flow, systemic PaO2, and oxygen delivery to the brain are very low during chest compressions for cardiac arrest irrespective of 21% or 100% inspired oxygen use during resuscitation.