Neonatal Hypovolemic Cardiac Arrest: Role of Early Rapid Volume Resuscitation

点击翻译按钮获取中文摘要

PROJECT SUMMARY/ ABSTRACT Birth asphyxia is a common cause of perinatal mortality. In some infants, loss of fetal blood volume contributes to asphyxia. The role of volume replacement in newborns affected by fetal blood loss (e.g., fetal-maternal hemorrhage), resulting in hypovolemia and hypoxia is poorly understood. For severe bradycardia or cardiac arrest associated with fetal blood loss, the current standard neonatal resuscitation guidelines recommend intravenous epinephrine with subsequent use of volume expanders (normal saline or red blood cells) administered slowly over 5 to 10 minutes. Such volume replacement is reserved for newborns not responding to ventilation, chest compressions, and epinephrine. This approach may not be effective to result in return of spontaneous circulation due to lack of adequate preload to the heart following acute blood loss. Early rapid volume replacement over 2 minutes may potentially increase the incidence of and hasten the return of spontaneous circulation. Emergent situation, inability to predict birth asphyxia and ethical concerns preclude performance of prospective clinical studies comparing early, rapid volume replacement and delayed slower volume replacement in human neonates. The 2020 Neonatal Life Support Task force in International Liaison Committee on Resuscitation (ILCOR) has identified volume replacement as a knowledge gap for neonatal providers. The current recommendations are based on expert opinion that the benefits outweigh the risks. We propose to perform a randomized trial comparing early rapid saline bolus during neonatal resuscitation, standard neonatal resuscitation (with slower volume replacement) and no volume replacement (placebo) in a perinatal term ovine model of hypovolemic asphyxial cardiac arrest. We hypothesize that early and rapid volume replacement during neonatal resuscitation will increase the incidence of return of spontaneous circulation in hypovolemic asphyxial cardiac arrest.