新生儿复苏中连续胸外按压和高频叩击通气在早产羔羊中的应用。
Neonatal resuscitation with continuous chest compressions and high frequency percussive ventilation in preterm lambs.
机构信息
Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento, CA, USA.
D-5 Neonatal Units, Patient Care Services, University of California, Davis Health, Sacramento, CA, USA.
出版信息
Pediatr Res. 2024 Jan;95(1):160-166. doi: 10.1038/s41390-023-02820-x. Epub 2023 Sep 19.
BACKGROUND
Cerebral oxygen delivery (cDO) is low during chest compressions (CC). We hypothesized that gas exchange and cDO are better with continuous CC with high frequency percussive ventilation (CCC + HFPV) compared to conventional 3:1 compressions-to-ventilation (C:V) resuscitation during neonatal resuscitation in preterm lambs with cardiac arrest induced by umbilical cord compression.
METHODS
Fourteen lambs in cardiac arrest were randomized to 3:1 C:V resuscitation (90CC + 30 breaths/min) per the Neonatal Resuscitation Program guidelines or CCC + HFPV (120CC + HFPV continuously). Intravenous epinephrine was given every 3 min until return of spontaneous circulation (ROSC).
RESULTS
There was no difference in the incidence and time to ROSC between both groups. Median (IQR) PaCO was significantly lower with CCC + HFPV during CC, at ROSC and 15 min post-ROSC-[104 (99-112), 83 (77-99), and 43 (40-64)], respectively compared to 3:1 C:V-[149 (139-167), 153 (143-168), and 153 (138-178) mmHg. PaO and cDO were higher with CCC + HFPV during CC and at ROSC. PaO was similar 15 min post-ROSC with a lower FiO in the CCC + HFPV group 0.4 (0.4-0.5) vs. 1 (0.6-1).
CONCLUSION
In preterm lambs with perinatal cardiac-arrest, continuous chest compressions with HFPV does not improve ROSC but enhances gas exchange and increases cerebral oxygen delivery compared to 3:1 C:V during neonatal resuscitation.
IMPACT STATEMENT
Ventilation is the most important intervention in newborn resuscitation. Currently recommended 3:1 compression-to-ventilation ratio is associated with hypercarbia and poor oxygen delivery to the brain. Providing uninterrupted continuous chest compressions during high frequency percussive ventilation is feasible in a lamb model of perinatal cardiac arrest, and demonstrates improved gas exchange and oxygen delivery to the brain. This is the first study in premature lambs evaluating high frequency percussive ventilation with asynchronous chest compressions and lays the groundwork for future clinical studies to optimize gas exchange and hemodynamics during chest compressions in newborns.
背景
在进行胸部按压时，脑氧输送（cDO）较低。我们假设与传统的新生儿复苏中 3:1 按压通气（C:V）相比，在因脐带压迫导致心跳骤停的早产羔羊中，使用高频胸壁按压（CCC + HFPV）进行连续 CCC 可改善气体交换和 cDO。
方法
将 14 只处于心脏骤停状态的羔羊随机分为接受新生儿复苏方案指南推荐的 3:1 C:V 复苏（90 次按压 + 30 次/min 通气）或 CCC + HFPV（120 次按压 + 持续 HFPV）。每 3 分钟给予静脉内肾上腺素，直至自主循环恢复（ROSC）。
结果
两组之间 ROSC 的发生率和时间无差异。与 3:1 C:V 相比，在进行 CCC 时、ROSC 时和 ROSC 后 15 分钟时，CCC + HFPV 组的 PaCO 中位数（IQR）更低[分别为 104（99-112）、83（77-99）和 43（40-64）mmHg]。在进行 CCC 时和 ROSC 时，CCC + HFPV 组的 PaO 和 cDO 更高。在 ROSC 后 15 分钟时，两组的 PaO 相似，但 CCC + HFPV 组的 FiO 较低（0.4 [0.4-0.5] vs. 1 [0.6-1]）。
结论
在围产期心跳骤停的早产羔羊中，与 3:1 C:V 相比，高频胸壁按压联合连续胸部按压不会提高 ROSC，但可增强气体交换并增加脑氧输送。
意义
在新生儿复苏中，通气是最重要的干预措施。目前推荐的 3:1 按压通气比值与高碳酸血症和脑氧输送不良有关。在围产期心跳骤停的羔羊模型中，高频胸壁按压期间提供不间断的连续胸部按压是可行的，并显示出改善的气体交换和脑氧输送。这是第一项在早产羔羊中评估高频胸壁按压联合异步胸部按压的研究，为未来优化新生儿胸部按压期间气体交换和血液动力学的临床研究奠定了基础。
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