Vali Payam, Chandrasekharan Praveen, Rawat Munmun, Gugino Sylvia, Koenigsknecht Carmon, Helman Justin, Mathew Bobby, Berkelhamer Sara, Nair Jayasree, Wyckoff Myra, Lakshminrusimha Satyan
Pediatrics, UC Davis, Sacramento, California, United States of America.
Pediatrics, SUNY University at Buffalo, Buffalo, New York, United States of America.
PLoS One. 2017 Apr 25;12(4):e0176478. doi: 10.1371/journal.pone.0176478. eCollection 2017.
Current knowledge about pulmonary/systemic hemodynamics and gas exchange during neonatal resuscitation in a model of transitioning fetal circulation with fetal shunts and fluid-filled alveoli is limited. Using a fetal lamb asphyxia model, we sought to determine whether hemodynamic or gas-exchange parameters predicted successful return of spontaneous circulation (ROSC).
The umbilical cord was occluded in 22 lambs to induce asphyxial cardiac arrest. Following five minutes of asystole, resuscitation as per AHA-Neonatal Resuscitation Program guidelines was initiated. Hemodynamic parameters and serial arterial blood gases were assessed during resuscitation.
ROSC occurred in 18 lambs (82%) at a median (IQR) time of 120 (105-180) seconds. There were no differences in hemodynamic parameters at baseline and at any given time point during resuscitation between the lambs that achieved ROSC and those that did not. Blood gases at arrest prior to resuscitation were comparable between groups. However, lambs that achieved ROSC had lower PaO2, higher PaCO2, and lower lactate during resuscitation. Increase in diastolic blood pressures induced by epinephrine in lambs that achieved ROSC (11 ±4 mmHg) did not differ from those that were not resuscitated (10 ±6 mmHg). Low diastolic blood pressures were adequate to achieve ROSC.
Hemodynamic parameters in a neonatal lamb asphyxia model with transitioning circulation did not predict success of ROSC. Lactic acidosis, higher PaO2 and lower PaCO2 observed in the lambs that did not achieve ROSC may represent a state of inadequate tissue perfusion and/or mitochondrial dysfunction.
在一个具有胎儿分流和充满液体肺泡的过渡性胎儿循环模型中，目前关于新生儿复苏期间肺/体循环血流动力学和气体交换的知识有限。我们使用胎羊窒息模型，试图确定血流动力学或气体交换参数是否能预测自主循环恢复（ROSC）成功。
在22只羔羊中阻断脐带以诱导窒息性心脏骤停。心搏停止5分钟后，按照美国心脏协会新生儿复苏计划指南开始复苏。在复苏过程中评估血流动力学参数和系列动脉血气。
18只羔羊（82%）实现了ROSC，中位（IQR）时间为120（105 - 180）秒。实现ROSC的羔羊与未实现ROSC的羔羊在基线和复苏期间任何给定时间点的血流动力学参数没有差异。复苏前心搏停止时的血气在两组之间具有可比性。然而，实现ROSC的羔羊在复苏期间的动脉血氧分压较低、动脉血二氧化碳分压较高且乳酸水平较低。肾上腺素诱导实现ROSC的羔羊舒张压升高（11±4 mmHg）与未复苏的羔羊（10±6 mmHg）没有差异。低舒张压足以实现ROSC。
在具有过渡性循环的新生羔羊窒息模型中，血流动力学参数不能预测ROSC是否成功。在未实现ROSC的羔羊中观察到的乳酸酸中毒、较高的动脉血氧分压和较低的动脉血二氧化碳分压可能代表组织灌注不足和/或线粒体功能障碍的状态。
