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，需要最佳反应才能获得最大生存率和神经学结局。关键的心肺复苏（CPR）技能，如胸外按压，是基于任意的建议（深度为前后径的1/3），导致难以掌握。基于生理反应的新型CPR技术的发展提供了关于CPR努力的有效性的实时、连续反馈，这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者调整按压的速率和深度，以使生理反应最大化，而不管诸如受害者的年龄或大小或停止的原因或持续时间等因素。我们已经开发了一种新的技术，使用呼气末二氧化碳（ETCO 2）-定向CPR在临床前的“儿科”模型（心脏引起的病因通过心室颤动）的心脏休止，产生的生存率和除颤率相当于最佳标准的儿科CPR。我们建议使用小猪心脏骤停的临床前“新生儿”模型（窒息引起的病因学）来比较ETCO 2定向胸外按压与优化标准新生儿基本生命支持（BLS）的使用。在窒息诱导的心脏骤停中测试ETCO 2指导的CPR非常重要，因为在窒息期间没有通气的持续心输出量将产生比心输出量在通气之前停止的心脏诱导的心脏骤停更高的CO2水平。与优化标准新生儿CPR相比，初始CO2负荷的增加可能会影响ETCO 2水平对直接胸外按压的有效性。我们还建议研究ETCO 2指导的CPR在先前呼吸衰竭水平增加的情况下的有效性，以确定窒息前呼吸衰竭对两种CPR方法的影响。这项研究将有助于回答这个新的心肺复苏技术在典型的新生儿复苏的逮捕情况下的有用性的问题。最后，我们将研究窒息持续时间对 这两种CPR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。所有三项研究都包括BLS和高级生命支持（ALS）阶段，以使我们能够确定肾上腺素给药对这种新型CPR方法的影响。ETCO 2引导的胸外按压至少与最佳标准新生儿BLS和ALS一样有效的证明将作为ETCO 2引导的胸外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ETCO 2引导的CPR的这种新颖的基于生理学的技术在新生儿骤停场景中是有效的将允许救援人员专注于维持对按压的最佳响应，而不是专注于经常导致性能不足的任意参数。

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.