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，需要最佳的反应才能获得最大的生存率和神经系统预后。关键的心肺复苏（CPR）技能，如胸外按压是基于任意的建议（深度为前后直径的1/3），这给掌握带来了困难。开发一种基于生理反应的新型CPR技术，提供实时、持续的心肺复苏术效果反馈，将对新生儿复苏做出重大贡献。即时的、基于生理的反馈使救援人员能够调整按压的速度和深度，以最大限度地提高生理反应，而不受受害者年龄、体型、原因或骤停时间等因素的影响。我们开发了一种新的技术，在临床前“儿科”模型中使用潮末二氧化碳（ETCO2）引导心肺复苏术（心脏诱发的心室颤动病因），产生与最佳标准儿科心肺复苏术相当的存活率和除颤率。我们建议使用临床前“新生儿”模型（通过窒息引起的呼吸诱发病因）来比较使用etco2定向胸外按压与优化标准新生儿基本生命支持（BLS）。在呼吸性骤停中测试etco2引导的心肺复苏术是很重要的，因为在窒息期间不通气的持续心输出量会比在通气前心输出量停止的心源性骤停产生更高的CO2水平。与优化的标准新生儿心肺复苏术相比，初始二氧化碳负担的增加可能会影响ETCO2水平直接胸外按压的有效性。我们还建议研究在先前呼吸衰竭水平升高的情况下，以etco2为导向的心肺复苏的有效性，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颖的心肺复苏术在新生儿复苏的典型情况下的有用性的问题。最后，我们将研究窒息时间对有用性的影响

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.