Rawat Munmun, Mani Srinivasan, Gugino Sylvia F, Koenigsknecht Carmon, Helman Justin, Nielsen Lori, Nair Jayasree, Munshi Upender, Chandrasekharan Praveen, Lakshminrusimha Satyan
Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA.
Department of Pediatrics, University of Toledo, Toledo, OH 43606, USA.
Children (Basel). 2023 Nov 13;10(11):1804. doi: 10.3390/children10111804.
The goal of chest compressions during neonatal resuscitation is to increase cerebral and coronary blood flow leading to the return of spontaneous circulation (ROSC). During chest compressions, bilateral femoral occlusion may increase afterload and promote carotid and coronary flow, an effect similar to epinephrine. Our objectives were to determine the impact of bilateral femoral occlusion during chest compressions on the incidence and timing of ROSC and hemodynamics.
In this randomized study, 19 term fetal lambs in cardiac arrest were resuscitated based on the Neonatal Resuscitation Program guidelines and randomized into two groups: femoral occlusion or controls. Bilateral femoral arteries were occluded by applying pressure using two fingers during chest compressions.
Seventy percent (7/10) of the lambs in the femoral occlusion group achieved ROSC in 5 ± 2 min and three lambs (30%) did not receive epinephrine. ROSC was achieved in 44% (4/9) of the controls in 13 ± 6 min and all lambs received epinephrine. The femoral occlusion group had higher diastolic blood pressures, carotid and coronary blood flow.
Femoral occlusion resulted in faster and higher incidence of ROSC, most likely due to attaining increased diastolic pressures, coronary and carotid flow. This is a low-tech intervention that can be easily adapted in resource limited settings, with the potential to improve survival and neurodevelopmental outcomes.
新生儿复苏期间胸外按压的目标是增加脑和冠状动脉血流,从而实现自主循环恢复(ROSC)。在胸外按压期间,双侧股动脉闭塞可能会增加后负荷并促进颈动脉和冠状动脉血流,其效果类似于肾上腺素。我们的目标是确定胸外按压期间双侧股动脉闭塞对ROSC的发生率、发生时间和血流动力学的影响。
在这项随机研究中,19只足月心脏骤停的胎羊按照新生儿复苏计划指南进行复苏,并随机分为两组:股动脉闭塞组或对照组。在胸外按压期间用两根手指施加压力来闭塞双侧股动脉。
股动脉闭塞组70%(7/10)的羔羊在5±2分钟内实现了ROSC,3只羔羊(30%)未接受肾上腺素治疗。对照组44%(4/9)的羔羊在13±6分钟内实现了ROSC,所有羔羊均接受了肾上腺素治疗。股动脉闭塞组的舒张压、颈动脉和冠状动脉血流更高。
股动脉闭塞导致ROSC更快出现且发生率更高,这很可能是由于舒张压、冠状动脉和颈动脉血流增加所致。这是一种技术要求不高的干预措施,在资源有限的环境中易于采用,有可能改善生存和神经发育结局。