End-tidal carbon dioxide (ETCO2) directed cardiopulmonary resuscitation (CPR)

描述(由申请人提供)：新生儿心脏骤停是一种罕见的高风险事件，需要最佳的反应以获得最大的存活率和神经系统结果。关键的心肺复苏(CPR)技巧，如胸部按压，是基于随意性的建议(深度为前后径的1/3)，这会增加掌握难度。开发一种基于生理反应的新型CPR技术，提供有关CPR效果的实时、持续反馈，将是对新生儿复苏的重大贡献。即时的、基于生理的反馈允许救援人员调整按压的速度和深度，以最大限度地提高生理反应，而不考虑受害者的年龄或体型、逮捕的原因或持续时间等因素。我们开发了一种新的技术，使用呼气末二氧化碳(ETCO2)指导的CPR在临床前的儿科模型(通过室颤引起的心脏病因学)中产生与最佳标准儿科CPR相同的存活率和除颤率。我们建议使用临床前的仔猪心脏骤停的“新生儿”模型(通过窒息引起的呼吸病因学)来比较使用ETCO2指导的胸部按压和优化的标准新生儿基本生命支持(BLS)。在呼吸诱导停搏时测试ETCO2指导的CPR是很重要的，因为在窒息期间持续的心输出量而不进行呼吸会产生比心脏诱导停止时更高的二氧化碳水平，在心脏停搏时心输出量在呼吸前停止。与优化的标准新生儿CPR相比，初始二氧化碳负荷的增加可能会影响ETCO2水平指导胸外按压的有效性。我们还建议研究ETCO2导向心肺复苏的有效性，以确定窒息前呼吸衰竭对两种心肺复苏方法的影响。这项研究将有助于回答有关这种新的CPR技术在新生儿复苏典型的逮捕场景中的有效性的问题。最后，我们将研究窒息持续时间对 两种心肺复苏方法。初步数据似乎表明，当损伤严重时，基于生理学的CPR可能比标准CPR更有用。所有这三项研究都包括BLS和高级生命支持(ALS)的周期，以使我们能够确定肾上腺素的应用对这种新的CPR方法的影响。ETCO2指导的胸部按压至少与最佳标准新生儿BLS和ALS一样有效，这将成为ETCO2指导胸部按压的临床研究和其他基于生理学的CPR应用的进一步临床前研究的基础。表明这种基于生理学的ETCO2导向CPR技术在新生儿骤停情况下是有效的，这将使救援人员能够专注于保持对按压的最佳反应，而不是经常导致性能不佳的任意参数。

DESCRIPTION (provided by applicant): Neonatal cardiac arrest is an infrequent, high-stakes event that requires optimal response for maximal survival and neurologic outcome. Key cardiopulmonary resuscitation (CPR) skills such as chest compressions are based on arbitrary recommendations (a depth of 1/3 the anteroposterior diameter) that contribute to difficulty in mastery. The development of a novel CPR technique based on a physiologic response that provides real-time, continuous feedback about the effectiveness of CPR efforts would be a major contribution to neonatal resuscitation. Immediate, physiology-based, feedback allows the rescuer to adjust the rate and depth of compressions to maximize the physiologic response despite factors such as the victim's age or size or the cause or duration of arrest. We have developed a novel technique using end-tidal carbon dioxide (ETCO2)- directed CPR in a preclinical "pediatric" model (cardiac-induced etiology via ventricular fibrillation) of cardiac arest that produces survival and defibrillation rates equivalent to those of optimal standard pediatric CPR. We propose to use a preclinical "neonatal" model (respiratory-induced etiology via asphyxia) of cardiac arrest in piglets to compare the use of ETCO2-directed chest compressions to optimized-standard neonatal basic life support (BLS). It is important to test ETCO2-directed CPR in a respiratory-induced arrest, as the continued cardiac output without ventilation during asphyxia will produce higher CO2 levels than the cardiac-induced arrest in which cardiac output stops before ventilation. This increase in the initial CO2 burden may have an impact on the effectiveness of ETCO2 levels to direct chest compressions in comparison to optimized-standard neonatal CPR. We also propose to study the effectiveness of ETCO2-directed CPR in the setting of increased levels of preceding respiratory failure to determine the effect of respiratory failure prior to asphyxia on both methods of CPR. This study will help to answer questions about the usefulness of this novel CPR technique in arrest scenarios typical for neonatal resuscitation. Finally, we will study the effect of asphyxia duration on the usefulness of both methods of CPR. Preliminary data appear to indicate that physiology-based CPR may be more useful than standard CPR when injury is severe. All three studies include periods of BLS and advanced life support (ALS) to enable us to determine the impact of epinephrine administration on this novel method of CPR. The demonstration that ETCO2-directed chest compressions are at least as effective as optimal standard neonatal BLS and ALS will serve as the basis for clinical studies of ETCO2-directed chest compressions and further preclinical studies of other physiology-based CPR applications. Showing that this novel physiology- based technique of ETCO2-directed CPR is effective in neonatal arrest scenarios would allow rescuers to focus on maintaining optimal response to compressions rather than on arbitrary parameters that frequently result in inadequate performance.