Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada (G.M.S., MO., T.-F.L., P.-Y.C.); Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada (G.M.S., M.O., S.C., S.Q., P.-Y.C.); Department of Pediatrics, Medical University Graz, Graz, Austria (G.M.S.); Department of Surgery, University of Alberta, Edmonton, Alberta, Canada (J.L., D.L.B., P.-Y.C.); and Faculty of Science, University of Alberta, Edmonton, Alberta, Canada (S.C.).
Circulation. 2013 Dec 3;128(23):2495-503. doi: 10.1161/CIRCULATIONAHA.113.002289. Epub 2013 Oct 2.
Guidelines on neonatal resuscitation recommend 90 chest compressions (CCs) and 30 manual inflations (3:1) per minute in newborns. The study aimed to determine whether CC s during sustained inflations (SIs) improves the recovery of asphyxiated newborn piglets in comparison with coordinated 3:1 resuscitation.
Term newborn piglets (n=8/group) were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by asphyxia. Piglets were randomly assigned to receive either 3:1 resuscitation (3:1 group) or CCs during SIs (SI group) when the heart rate decreased to 25% of baseline. Piglets randomly assigned to the SI group received SIs with a pressure of 30 cm H2O for 30 s. During the SI, CCs at a rate of 120/min were provided. SI was interrupted after 30 s for 1 s before a further 30-s SI was provided. CCs were continued throughout SIs. CCs and SI were continued until the return of spontaneous circulation. Continuous respiratory parameters, cardiac output, mean systemic and pulmonary artery pressures, and regional blood flows were measured. Mean (standard deviation) time for return of spontaneous circulation was significantly reduced in SI group versus 3:1 group (32 [11] s versus 205 [113] s, respectively). In the SI group, administration of oxygen and epinephrine was significantly lower, whereas minute ventilation and exhaled CO2 were significantly increased. The SI group had significantly higher mean systemic and pulmonary arterial pressures during resuscitation in comparison with the 3:1 group (51 [10] versus 31 [5] mm Hg; 41[7] versus 31 [7] mm Hg, respectively; all P<0.05), with improved cardiac output and carotid blood flow.
Combining CCs and SIs significantly improved the return of spontaneous circulation with better hemodynamic recovery in asphyxiated newborn piglets in comparison with standard coordinated 3:1 resuscitation.
新生儿复苏指南建议，新生儿每分钟进行 90 次胸外按压（CCs）和 30 次手动通气（3:1）。本研究旨在确定在持续通气（SIs）期间进行 CCs 是否比协调的 3:1 复苏更能改善窒息新生仔猪的复苏。
将足月新生仔猪（每组 8 只）麻醉、插管、仪器化，并暴露于 45 分钟常压缺氧，随后窒息。仔猪被随机分配接受 3:1 复苏（3:1 组）或 SIs 期间进行 CCs（SI 组），当心率降至基线的 25%时。随机分配到 SI 组的仔猪接受压力为 30 cm H2O 的 SIs 30 s。在 SI 期间，以 120/min 的速度提供 CCs。30 s 后，SI 中断 1 s，然后再提供 30 s 的 SI。在整个 SIs 期间继续进行 CCs。CCs 和 SI 持续进行，直到自主循环恢复。连续测量呼吸参数、心输出量、平均全身和肺动脉压以及局部血流。SI 组与 3:1 组相比，自主循环恢复的平均（标准差）时间显著缩短（32 [11] s 与 205 [113] s 相比，分别）。在 SI 组中，给予氧气和肾上腺素的量显著减少，而分钟通气量和呼出的 CO2 显著增加。与 3:1 组相比，SI 组在复苏期间的平均全身和肺动脉压明显升高（分别为 51 [10] 与 31 [5] mmHg；41[7] 与 31 [7] mmHg；所有 P<0.05），心输出量和颈动脉血流也有所改善。
与标准协调的 3:1 复苏相比，CCs 和 SIs 的联合使用可显著提高窒息新生仔猪的自主循环恢复率，并改善其血流动力学恢复。
