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.

项目概要/摘要 出生窒息是围产儿死亡的常见原因。在某些婴儿中，胎儿血液流失 体积会导致窒息。容量替代在受胎儿影响的新生儿中的作用 失血（例如胎儿-母体出血），导致血容量不足和缺氧 明白了。对于与胎儿失血相关的严重心动过缓或心脏骤停，目前 标准新生儿复苏指南建议静脉注射肾上腺素，随后 使用扩容剂（生理盐水或红细胞）缓慢给药 5 至 10 次 分钟。这种容量补充适用于对通气、胸部没有反应的新生儿。 按压和肾上腺素。这种方法可能无法有效地获得回报 由于急性失血后心脏缺乏足够的前负荷而导致的自主循环。 超过 2 分钟的早期快速容量补充可能会增加以下情况的发生率： 加速自主循环的恢复。情况紧急，无法预测出生窒息 伦理问题阻碍了前瞻性临床研究的进行，比较早期、快速 人类新生儿的容量置换和延迟较慢的容量置换。 2020年 国际复苏联络委员会 (ILCOR) 新生儿生命支持工作组 已将容量替代确定为新生儿提供者的知识差距。目前的 建议基于专家意见，即收益大于风险。 我们建议进行一项随机试验，比较早期快速盐水推注 新生儿复苏、标准新生儿复苏（容量补充较慢）和无 围产期绵羊低血容量窒息模型中的容量替代（安慰剂） 逮捕。我们假设新生儿复苏期间早期和快速的容量补充将 增加低血容量性窒息心脏自主循环恢复的发生率 逮捕。