Neonatal Hypovolemic Cardiac Arrest: Role of Early Rapid Volume Resuscitation

项目摘要/摘要 出生窒息是围产儿死亡的常见原因。在一些婴儿中，胎儿失血 体积会导致窒息。容量替换术在新生儿宫内窘迫中的作用 失血(例如，胎儿-产妇出血)，导致低血容量和缺氧的情况很差 明白了。对于与胎儿失血有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在随后的新生儿复苏中静脉注射肾上腺素 使用体积扩张器(生理盐水或红细胞)缓慢给药超过5至10 几分钟。这种容量替换是为对呼吸无反应的新生儿保留的，胸部 按压和肾上腺素。这种方法可能不会有效地导致返回 由于急性失血后心脏缺乏足够的预负荷而导致的自发性循环。 超过2分钟的早期快速容量替换可能会增加 加快自发性循环的回归。情况紧急，无法预测新生儿窒息 伦理方面的考虑排除了比较早期、快速的前瞻性临床研究的表现 新生儿的容量替换和延迟较慢的容量替换。2020年 国际复苏联络委员会新生儿生命支持工作队 已将数量替换确定为新生儿提供者的知识缺口。海流 建议是基于专家的意见，即好处大于风险。 我们建议进行一项随机试验，比较早期快速生理盐水丸在 新生儿复苏、标准新生儿复苏(使用较慢的容量替换)和无 容量替代(安慰剂)在围产期绵羊低血容量窒息心脏模型中的应用 逮捕。我们假设在新生儿复苏过程中早期和快速的容量替换将 低血容量性窒息心脏自主循环复苏率增加 逮捕。

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.