Udassi Sharda, Haque Ikram U, Lopez-Colon Dalia, Shih Andre, Vasudeva Dhanya, Kaliki-Venkata Giridhar, Weiss Michael, Zaritsky Arno L, Udassi Jai P
Division of General Pediatrics, Department of Pediatrics, Sidra Medicine, Doha Qatar.
Division of Pediatric Critical Care, Department of Pediatrics, Sidra Medicine, Doha Qatar.
Resusc Plus. 2021 Apr 14;6:100118. doi: 10.1016/j.resplu.2021.100118. eCollection 2021 Jun.
Two-Thumb(TT) technique provides superior quality chest compressions compared with Two-Finger(TF) in an instrumented infant manikin. Whether this translates to differences in blood flow, such as carotid arterial blood flow(CABF), has not been evaluated. We hypothesized that TT-CPR generates higher CABF and Coronary Perfusion Pressure(CPP) compared with TF-CPR in a neonatal swine cardiac arrest model.
Twelve anesthetized & ventilated piglets were randomized after 3 min of untreated VF to receive either TT-CPR or TF-CPR by PALS certified rescuers delivering a compression rate of 100/min. The primary outcome, CABF, was measured using an ultrasound transonic flow probe placed on the left carotid artery. CPP was calculated and end-tidal CO(ETCO) was measured during CPR. Data(mean ± SD) were analyzed and p-value ≤0.05 was considered statistically significant.
Carotid artery blood flow (% of baseline) was higher in TT-CPR (66.2 ± 35.4%) than in the TF-CPR (27.5 ± 10.6%) group, p = 0.013. Mean CPP (mm Hg) during three minutes of chest compression for TT-CPR was 12.5 ± 15.8 vs. 6.5 ± 6.7 in TF-CPR, p = 0.41 and ETCO (mm Hg) was 29.0 ± 7.4 in TT-CPR vs. 20.7 ± 5.8 in TF-CPR group, p = 0.055.
TT-CPR achieved more than twice the CABF compared with TF-CPR in a piglet cardiac arrest model. Although CPP and ETCO were higher during TT-CPR, these parameters did not reach statistical significance. This study provides direct evidence of increased blood flow in infant swine using TT-CPR and further supports that TT chest compression is the preferred method for CPR in infants.
在配备仪器的婴儿模型中，与两指（TF）技术相比，双拇指（TT）技术能提供质量更优的胸部按压。但这是否会转化为血流差异，如颈动脉血流（CABF），尚未得到评估。我们假设在新生猪心脏骤停模型中，与TF-CPR相比，TT-CPR能产生更高的CABF和冠状动脉灌注压（CPP）。
12只麻醉并通气的仔猪在未治疗的室颤3分钟后随机分组，由获得PALS认证的救援人员以每分钟100次的按压速率进行TT-CPR或TF-CPR。主要结局指标CABF通过置于左颈动脉的超声跨音速血流探头测量。在心肺复苏期间计算CPP并测量呼气末二氧化碳（ETCO）。分析数据（均值±标准差），p值≤0.05被认为具有统计学意义。
TT-CPR组的颈动脉血流（占基线的百分比）高于TF-CPR组（66.2±35.4%比27.5±10.6%），p = 0.013。TT-CPR胸部按压三分钟期间的平均CPP（mmHg）为12.5±15.8，而TF-CPR为6.5±6.7，p = 0.41；TT-CPR组的ETCO（mmHg）为29.0±7.4，TF-CPR组为20.7±5.8，p = 0.055。
在仔猪心脏骤停模型中，与TF-CPR相比，TT-CPR实现的CABF是其两倍多。尽管TT-CPR期间CPP和ETCO更高，但这些参数未达到统计学意义。本研究提供了使用TT-CPR增加幼猪血流的直接证据，并进一步支持TT胸部按压是婴儿心肺复苏的首选方法。
