Neonatal Hypovolemic Cardiac Arrest: Role of Early Rapid Volume Resuscitation

新生儿低血容量性心脏骤停：早期快速容量复苏的作用

• 批准号: 10739265
• 负责人: Deepika Sankaran
• 金额: $ 16万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10739265
• 关键词: Acute; Advisory Committees; Affect; Asphyxia; Asphyxia Neonatorum; Blood Pressure; Blood Volume; Blood flow; Blood gas; Bolus Infusion; Bradycardia; Brain natriuretic peptide; Cardiac; Cardiopulmonary Resuscitation; Central venous pressure; Cerebrovascular Circulation; Chest; Circulation; Clinical; Clinical Research; Clinical Trials; Delivery Rooms; Deterioration; Dose; Dryness; Epinephrine; Erythrocytes; Ethics; Expert Opinion; Fluid overload; Functional disorder; Future; Gases; Guidelines; Heart; Heart Arrest; Heart Injuries; Heart Rate; Hemorrhage; Human; Hypovolemia; Hypovolemics; Hypoxia; Immunoassay; Incidence; Infant; International; Intravenous; Knowledge; Left; Level of Evidence; Life; Liquid substance; Lung; Measures; Monitor; N-terminal; Neonatal; Newborn Infant; Normal saline; Outcome; Performance; Perinatal; Perinatal mortality demographics; Placebos; Plasma; Play; Premature Infant; Provider; Pulmonary Edema; Pump; Randomized; Recommendation; Resuscitation; Risk; Role; Saline; Secondary to; Sheep; Time; Troponin T; United States; Weight; arm; cerebral hemodynamics; crystalloid; experimental arm; fetal; fetal blood; fetal loss; intraventricular hemorrhage; lamb model; neonatal death; neonatal resuscitation; neonate; pressure; prospective; randomized trial; sheep model; tissue injury; trial comparing; ventilation

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.

项目摘要/摘要 出生窒息是围产期死亡率的常见原因。在某些婴儿中，胎儿血液流失 体积有助于窒息。体积替代在受胎儿影响的新生儿中的作用 失血（例如胎儿出血），导致低氧血症和低氧不良 理解。对于严重的心动过缓或与胎儿失血有关的心脏骤停， 标准的新生儿复苏指南建议静脉注射肾上腺素，随后 使用体积膨胀器（正常盐水或红细胞）在5至10中缓慢施用 分钟。此类量更换是为新生儿保留的，不响应通风，胸部 压缩和肾上腺素。这种方法可能无法有效地回报 急性失血后，由于缺乏足够的预紧力而引起的自发循环。 2分钟内的早期快速量更换可能会增加和 加快自发循环的回归。紧急情况，无法预测窒息 道德问题排除了前瞻性临床研究的表现，比较早期，快速 人类新生儿的体积更换和延迟较慢的体积更换。 2020年 国际复苏联络委员会（ILCOR）的新生儿生命支持工作队（ILCOR） 已将量替换为新生儿提供者的知识差距。电流 建议是基于专家意见，即收益大于风险。 我们建议进行一项随机试验，以比较在 新生儿复苏，标准的新生儿复苏（更换体积较慢）和否 在围产期术语卵巢沥青心脏的围产期术语中，体积更换（安慰剂） 逮捕。我们假设新生儿复苏期间的早期和快速量替换将 增加自发性循环疾病低血症心脏心脏的发生率 逮捕。