Giusto Evan, Sankaran Deepika, Riley Erin, Lesneski Amy, Persiani Michele, Valdez Rebecca, Hammitt Victoria L, Lakshminrusimha Satyan, Vali Payam
Neonatal, Patient Care Services, University of California, Davis Health, Sacramento, California, USA.
Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento, California, USA.
Neonatology. 2025 Aug 1:1-10. doi: 10.1159/000547332.
Gas exchange and perfusion are impaired during neonatal cardiopulmonary resuscitation. Continuous chest compressions with asynchronous ventilation (CCCaV) improve oxygenation and hemodynamics in term animal models compared to synchronized 3:1 compressions-to-ventilation (C:V). We hypothesized that CCCaV improves gas exchange and hemodynamics in preterm lambs.
Sixteen extremely preterm (124-126 days gestation) lambs were asphyxiated to cardiac arrest by umbilical cord occlusion. Lambs were randomized to 3:1 C:V following the International Liaison Committee on Resuscitation algorithm or CCCaV (120 compressions and 40 asynchronized ventilations per minute). Epinephrine was given 3 min into resuscitation and repeated every 3 min until return of spontaneous circulation (ROSC).
All lambs achieved ROSC with no difference in time to ROSC. There was no difference in cerebral oxygen delivery (C-DO) in lambs resuscitated with CCCaV versus 3:1 C:V (0.05 [0.041] vs. 0.03 [0.031] mL O/kg/min, respectively) during chest compressions. CCCaV yielded higher arterial oxygen content (CaO 2.07 [1.00] vs. 1.07 [0.69] mL O/dL), mean arterial pressure (14.2 [2.6] vs. 13.2 [2.3] mm Hg), and diastolic pressure (8.1 [1.8] vs. 7.1 [1.4] mm Hg) during chest compressions compared to 3:1 C:V. There was no difference in plasma reduced to oxidized glutathione [GSH/GSSG ratio] between groups at 10 min post-ROSC.
CCCaV in asystolic preterm lambs did not alter C-DO, frequency, or time to ROSC compared to standard 3:1 C:V resuscitation but increased CaO, mean, and diastolic arterial pressure compared to 3:1 C:V without increasing plasma oxidative stress markers.
新生儿心肺复苏期间气体交换和灌注受损。与3:1同步按压通气（C:V）相比，持续胸外按压与非同步通气（CCCaV）可改善足月动物模型的氧合和血流动力学。我们假设CCCaV可改善早产羔羊的气体交换和血流动力学。
16只极早产（妊娠124 - 126天）羔羊通过脐带闭塞致心脏骤停。羔羊按照国际复苏联合委员会算法随机分为3:1 C:V组或CCCaV组（每分钟120次按压和40次非同步通气）。复苏3分钟时给予肾上腺素，每3分钟重复一次，直至自主循环恢复（ROSC）。
所有羔羊均实现ROSC，至ROSC的时间无差异。在胸外按压期间，与3:1 C:V组相比，CCCaV组复苏的羔羊脑氧输送（C - DO）无差异（分别为0.05 [0.041] 与0.03 [0.031] mL O/kg/min）。与3:1 C:V相比，CCCaV组在胸外按压期间动脉血氧含量更高（CaO 2.07 [1.00] 与1.07 [0.69] mL O/dL）、平均动脉压更高（14.2 [2.6] 与13.2 [2.3] mmHg）、舒张压更高（8.1 [1.8] 与7.1 [1.4] mmHg）。ROSC后10分钟两组间血浆还原型与氧化型谷胱甘肽[GSH/GSSG比值]无差异。
与标准3:1 C:V复苏相比，心搏停止的早产羔羊采用CCCaV未改变C - DO、频率或至ROSC的时间，但与3:1 C:V相比增加了CaO、平均动脉压和舒张压，且未增加血浆氧化应激标志物。
