Mendler Marc R, Weber Claudia, Hassan Mohammad A, Huang Li, Waitz Markus, Mayer Benjamin, Hummler Helmut D
Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany.
Neonatology. 2016;109(1):22-30. doi: 10.1159/000439020. Epub 2015 Oct 14.
There are no clear evidence-based recommendations on the use of different techniques of respiratory support and chest compressions (CC) during neonatal cardiopulmonary resuscitation (CPR).
To determine the effects of different respiratory support strategies along with CC representing clinical practice on the return of spontaneous circulation (ROSC) in hypoxic newborn piglets with cardiac arrest. We hypothesized that use of a T-piece resuscitator (TPR) providing positive end-expiratory pressure (PEEP) reduces time to ROSC as compared to a self-inflating bag (SIB) without PEEP. Furthermore, we explored the effects of a ventilator providing inflations without synchrony to CC.
Thirty-three newborn piglets were exposed to hypoxia until asystole occurred and randomized into three groups and resuscitated according to ILCOR guidelines: group 1 = TPR [peak inspiratory pressure (PIP)/PEEP of 25/5 cm H2O, rate 30/min], inflations interposed between CC (3:1 ratio); group 2 = SIB (PIP of 25 cm H2O without PEEP, rate 30/min), inflations interposed between CC (3:1 ratio), and group 3 = ventilator (PIP/PEEP of 25/5 cm H2O, rate 30/min), CC were applied with a rate of 120/min without synchrony to inflations. Animals were supported for 120 min after ROSC. Primary outcome was time to ROSC.
All animals achieved ROSC. We found no significant difference in time to ROSC between groups [median (IQR); TPR: 150 s (150-210); SIB: 150 s (120-180); ventilator: 180 s (150-345)]. There was no difference in use of epinephrine, in blood gases or hemodynamic parameters during the 120-min observation time after ROSC.
We found no significant effect of different respiratory support strategies during CPR on ROSC.
在新生儿心肺复苏（CPR）期间，对于使用不同的呼吸支持技术和胸外按压（CC），尚无明确的循证医学推荐。
确定不同的呼吸支持策略以及代表临床实践的CC对心脏骤停的低氧新生仔猪自主循环恢复（ROSC）的影响。我们假设，与未提供呼气末正压（PEEP）的自动充气式气囊（SIB）相比，使用提供PEEP的T形管复苏器（TPR）可缩短达到ROSC的时间。此外，我们探讨了提供充气但与CC不同步的呼吸机的影响。
33只新生仔猪暴露于低氧环境直至心搏停止，随机分为三组，并根据国际复苏联络委员会（ILCOR）指南进行复苏：第1组=TPR[吸气峰压（PIP）/PEEP为25/5 cmH₂O，频率30次/分钟]，在CC期间插入充气（3:1比例）；第2组=SIB（PIP为25 cmH₂O，无PEEP，频率30次/分钟），在CC期间插入充气（3:1比例），第3组=呼吸机（PIP/PEEP为25/5 cmH₂O，频率30次/分钟），CC以120次/分钟的频率进行，与充气不同步。在达到ROSC后对动物支持120分钟。主要结局是达到ROSC的时间。
所有动物均实现了ROSC。我们发现各组之间达到ROSC的时间无显著差异[中位数（四分位间距）；TPR：150秒（150 - 210）；SIB：150秒（120 - 180）；呼吸机：180秒（150 - 345）]。在达到ROSC后的120分钟观察期内，肾上腺素的使用、血气或血流动力学参数方面无差异。
我们发现在CPR期间不同的呼吸支持策略对ROSC无显著影响。
