Συγκριτική μελέτη αερισμού με διαφυγή και χωρίς διαφυγή στην έκβαση της παρατεταμένης νεογνικής ασφυξίας

Εισαγωγή: Η σοβαρή και παρατεταμένη ασφυξία μπορεί να έχει ως αποτέλεσμα είτε τον ενδομήτριο εμβρυϊκό θάνατο όσο και τον θάνατο στον τοκετό ή την πολυοργανική ανεπάρκεια στα επιζώντα νεογνά. Η διασφάλιση αποτελεσματικού αερισμού είναι ο πρωταρχικός στόχος της αναζωογόνησης σε νεογνά με ασφυξία. Σκοπός αυτής της μελέτης ήταν η διερεύνηση της έκβασης της παρατεταμένης νεογνικής ασφυξίας μετά από ανάνηψη που πραγματοποιείται με αερισμό με Ενδοτραχειακό Σωλήνα με διαφυγή ή χωρίς διαφυγή Υλικό και Μέθοδος: Πρόκειται για μια προοπτική, τυχαιοποιημένη ελεγχόμενη εργαστηριακή μελέτη. Χρησιμοποιήθηκαν 30 νεογνά χοιρίδια (Landrace/Large-White), ηλικίας 1-4 ημερών και βάρους 1.754±218 gr. Τα ζώα τυχαιοποιήθηκαν σε 3 διαφορετικές ομάδες ανάλογα με τον ενδοτραχειακό σωλήνα (ΕΤΤ) που είχαν διασωληνωθεί . Η Ομάδα C (ελάχιστη διαφυγή, ΕΤΤ no 4.0, n=10), Ομάδα A (μεγάλη διαφυγή, EΤΤ no 3.0, n=10) και η Ομάδα Β (μέτρια διαφυγή, ΕΤΤ no 3.5, n=10). Υποβλήθηκαν σε ασφυξία και αφέθηκαν χωρίς θεραπεία έως ότου ο καρδιακός ρυθμός ήταν μικρότερος από 60 bpm ή η μέση αρτηριακή πίεση ήταν κάτω από 15 mmHg. Σε όλα τα ζώα με ανάκτηση αυτόματης κυκλοφορίας (ROSC) παρακολουθούταν για 4 ώρες οι αιμοδυναμικές τους παράμετροι, ο αρτηριακός κορεσμός οξυγόνου και τα επίπεδα γαλακτικού οξέος. Αποτελέσματα: Βρέθηκε ότι το 70% των ζώων που επέζησαν οξυγονώνονταν με ΕΤΤ με διαφυγή (νούμερο 3,5 και 3). Παρατηρήθηκε στατιστικά σημαντική διαφορά στην PO2 (p=0,032) στο Group B (126.4±53,4 mmHg) σε σχέση με το Group A (72.28±29.18mmHg) και το Group C (94.28±20.46mmHg) και επίσης στη Πίεση του Δεξιού Κόλπου (p<0.001) ανάμεσα στο Group C (4,5mmHg) σε σχέση με τα Groups A (2mmHg) και B (2mmHg) στη φάση ROSC. Τα επίπεδα Γαλακτικού Οξέος ήταν στατιστικά σημαντικά χαμηλότερα (p=0.035) στο Group C (mean=0.92± 0.07mmol/L) σε σχέση με το Group A (mean=1.13±0.1mmol/L) και το Group B (mean= 1.08 ± 0.07mmol /L; p = 0.034) 4h μετά την φάση ROSC. Συμπέρασμα: Η μελέτη μας δείχνει ότι η διασωλήνωση με ΕΤΣ με διαφυγή βελτίωσε σημαντικά τη ROSC στα 30 δευτερόλεπτα και την επιβίωση σε μοντέλο χοίρου ανάνηψης νεογνών. Τα Landrace/Large λευκά χοιρίδια έχουν πολύ καλή προσαρμογή για τον πειραματισμό σε νεογνική υποξίαBackground: Severe and prolonged asphyxia can result in either intrauterine fetal death and stillbirth or multiorgan failure in surviving neonates. Establishing effective ventilation is the primary aim of resuscitation in newborns with asphyxia. The objective of this study was to compare the outcome of resuscitation by applying an endotracheal tube (ETT) with less, an ETT with moderate, and an ETT with high leakage during mechanical ventilation in swine neonates after a prolonged perinatal asphyxia. Methods: A prospective, randomized controlled laboratory study was performed. Thirty Landrace / Large-White pigs, aged 1-4 days and weighted 1.754±218gr, were randomly allocated into three groups depending on the ETT size: Group C (less leak: ETT no 4.0, n=10). Group A (high leak: ETT no 3.0, n=10) and Group B (moderate leak: ETT no 3.5, n=10). Mechanical asphyxia was performed until their heart rate was less than 60 bpm or their mean arterial pressure was below 15 mmHg. All animals with Return of Spontaneous Circulation (ROSC) were monitored for 4 hours for their hemodynamic parameters, arterial oxygen saturation and lactate acid levels. Results: We demonstrate that 70% of the surviving animals were ventilated with an ETT with leak (no 3.5 and 3). It was noted a statistically significant difference in PO2 (p=0.032) between Group B (126.4±53.4 mmHg) compared to Group A (72.28±29.18mmHg) and Group C (94.28±20.46mmHg) and also in the right atrial pressure (p<0.001) between Group C (4,5mmHg) vs Groups A (2mmHg) and B (2mmHg) during in ROSC time. Lactate levels were statistically significantly lower (p=0.035) in Group C (mean=0.92 ± 0.07mmol/L) compared to Group A (mean=1.13 ± 0.1mmol/L) and Group B (mean= 1.08 ± 0.07mmol /L; p = 0.034) at 4h post-ROSC. Conclusion: We provide preliminary evidence that ventilation with ETT with moderate leakage improves survival after 2h of ROSC, along with oxygenation and hemodynamic parameters in a porcine model of neonatal asphyxia and resuscitation, compared to less leakage ETT

A comparative study of ventilation with or without endotracheal tube leak at the outcome of prolonged neonatal asphyxia

Background: Severe and prolonged asphyxia can result in either intrauterine fetal death and stillbirth or multiorgan failure in surviving neonates. Establishing effective ventilation is the primary aim of resuscitation in newborns with asphyxia. The objective of this study was to compare the outcome of resuscitation by applying an endotracheal tube (ETT) with less, an ETT with moderate, and an ETT with high leakage during mechanical ventilation in swine neonates after a prolonged perinatal asphyxia. Methods: A prospective, randomized controlled laboratory study was performed. Thirty Landrace / Large-White pigs, aged 1-4 days and weighted 1.754±218gr, were randomly allocated into three groups depending on the ETT size: Group C (less leak: ETT no 4.0, n=10). Group A (high leak: ETT no 3.0, n=10) and Group B (moderate leak: ETT no 3.5, n=10). Mechanical asphyxia was performed until their heart rate was less than 60 bpm or their mean arterial pressure was below 15 mmHg. All animals with Return of Spontaneous Circulation (ROSC) were monitored for 4 hours for their hemodynamic parameters, arterial oxygen saturation and lactate acid levels.Results: We demonstrate that 70% of the surviving animals were ventilated with an ETT with leak (no 3.5 and 3). It was noted a statistically significant difference in PO2 (p=0.032) between Group B (126.4±53.4 mmHg) compared to Group A (72.28±29.18mmHg) and Group C (94.28±20.46mmHg) and also in the right atrial pressure (p<0.001) between Group C (4,5mmHg) vs Groups A (2mmHg) and B (2mmHg) during in ROSC time. Lactate levels were statistically significantly lower (p=0.035) in Group C (mean=0.92 ± 0.07mmol/L) compared to Group A (mean=1.13 ± 0.1mmol/L) and Group B (mean= 1.08 ± 0.07mmol /L; p = 0.034) at 4h post-ROSC. Conclusion: We provide preliminary evidence that ventilation with ETT with moderate leakage improves survival after 2h of ROSC, along with oxygenation and hemodynamic parameters in a porcine model of neonatal asphyxia and resuscitation, compared to less leakage ETT.Εισαγωγή: Η σοβαρή και παρατεταμένη ασφυξία μπορεί να έχει ως αποτέλεσμα είτε τον ενδομήτριο εμβρυϊκό θάνατο όσο και τον θάνατο στον τοκετό ή την πολυοργανική ανεπάρκεια στα επιζώντα νεογνά. Η διασφάλιση αποτελεσματικού αερισμού είναι ο πρωταρχικός στόχος της αναζωογόνησης σε νεογνά με ασφυξία. Σκοπός αυτής της μελέτης ήταν η διερεύνηση της έκβασης της παρατεταμένης νεογνικής ασφυξίας μετά από ανάνηψη που πραγματοποιείται με αερισμό με Ενδοτραχειακό Σωλήνα με διαφυγή ή χωρίς διαφυγή. Υλικό και Μέθοδος: Πρόκειται για μια προοπτική, τυχαιοποιημένη ελεγχόμενη εργαστηριακή μελέτη. Χρησιμοποιήθηκαν 30 νεογνά χοιρίδια (Landrace/Large-White), ηλικίας 1-4 ημερών και βάρους 1.754±218 gr. Τα ζώα τυχαιοποιήθηκαν σε 3 διαφορετικές ομάδες ανάλογα με τον ενδοτραχειακό σωλήνα (ΕΤΤ) που είχαν διασωληνωθεί . Η Ομάδα C (ελάχιστη διαφυγή, ΕΤΤ no 4.0, n=10), Ομάδα A (μεγάλη διαφυγή, EΤΤ no 3.0, n=10) και η Ομάδα Β (μέτρια διαφυγή, ΕΤΤ no 3.5, n=10). Υποβλήθηκαν σε ασφυξία και αφέθηκαν χωρίς θεραπεία έως ότου ο καρδιακός ρυθμός ήταν μικρότερος από 60 bpm ή η μέση αρτηριακή πίεση ήταν κάτω από 15 mmHg. Σε όλα τα ζώα με ανάκτηση αυτόματης κυκλοφορίας (ROSC) παρακολουθούταν για 4 ώρες οι αιμοδυναμικές τους παράμετροι, ο αρτηριακός κορεσμός οξυγόνου και τα επίπεδα γαλακτικού οξέος.Αποτελέσματα: Βρέθηκε ότι το 70% των ζώων που επέζησαν οξυγονώνονταν με ΕΤΤ με διαφυγή (νούμερο 3,5 και 3). Παρατηρήθηκε στατιστικά σημαντική διαφορά στην PO2 (p=0,032) στο Group B (126.4±53,4 mmHg) σε σχέση με το Group A (72.28±29.18mmHg) και το Group C (94.28±20.46mmHg) και επίσης στη Πίεση του Δεξιού Κόλπου (p<0.001) ανάμεσα στο Group C (4,5mmHg) σε σχέση με τα Groups A (2mmHg) και B (2mmHg) στη φάση ROSC. Τα επίπεδα Γαλακτικού Οξέος ήταν στατιστικά σημαντικά χαμηλότερα (p=0.035) στο Group C (mean=0.92± 0.07mmol/L) σε σχέση με το Group A (mean=1.13±0.1mmol/L) και το Group B (mean= 1.08 ± 0.07mmol /L; p = 0.034) 4h μετά την φάση ROSC. Συμπέρασμα: Η μελέτη μας δείχνει ότι η διασωλήνωση με ΕΤΣ με διαφυγή βελτίωσε σημαντικά τη ROSC στα 30 δευτερόλεπτα και την επιβίωση σε μοντέλο χοίρου ανάνηψης νεογνών. Τα Landrace/Large λευκά χοιρίδια έχουν πολύ καλή προσαρμογή για τον πειραματισμό σε νεογνική υποξί

A comparison between the two methods of chest compression in infant and neonatal resuscitation. A review according to 2010 CPR guidelines

Aim: The quality of chest compression (CC) delivered during neonatal and infant cardiopulmonary resuscitation (CPR) is identified as the most important factor to achieve the increase of survival rate without major neurological deficit to the patients. The objective of the study was to systematically review all the available studies that have compared the two different techniques of hand placement on infants and neonatal resuscitation, from 2010 to 2015 and to highlight which method is more effective. Methods: A review of the literature using a variety of medical databases, including Cochrane, MEDLINE, and SCOPUS electronic databases. The following MeSH terms were used in the search: infant, neonatal, CPR, CC, two-thumb (TT) technique/method, two-finger (TF) technique/method, rescuer fatigue, thumb/finger position/placement, as well as combinations of these. Results: Ten studies met the inclusion criteria; nine observational studies and a randomized controlled trial. All providers performed either continuous TF or TT technique CCs and the majority of CPR performance was taken place in infant trainer manikin. Conclusions: The majority of the studies suggest the TT method as the more useful for infants and neonatal resuscitation than the TF. © 2017 Informa UK Limited, trading as Taylor &amp; Francis Group

Ventilation With or Without Endotracheal Tube Leak in Prolonged Neonatal Asphyxia

Background Severe and prolonged asphyxia can result in either intrauterine fetal death and stillbirth or multiorgan failure in surviving neonates. Establishing effective ventilation is the primary aim of resuscitation in newborns with asphyxia. The objective of this study was to compare the outcome of resuscitation by applying an endotracheal tube (ETT) with less, an ETT with moderate, and an ETT with high leakage during mechanical ventilation in swine neonates after prolonged perinatal asphyxia. Materials and methods A prospective, randomized controlled laboratory study was performed. Thirty Landrace/large white pigs, aged one to four days and weighted 1.754 +/- 218 gr, were randomly allocated into three groups depending on the ETT size: Group C (less leak: ETT no 4.0, n=10); Group A (high leak: ETT no 3.0, n=10); and Group B (moderate leak: ETT no 3.5, n=10). Mechanical asphyxia was performed until their heart rate was less than 60 bpm or their mean arterial pressure was below 15 mmHg. All animals with return of spontaneous circulation (ROSC) were monitored for four hours for their hemodynamic parameters, arterial oxygen saturation, and lactate acid levels. Results We demonstrate that 70% of the surviving animals were ventilated with an ETT with a leak (no. 3.5 and 3). A statistically significant difference was noted in PO2 (p=0.032) between Group B (126.4 +/- 53.4 mmHg) compared to Group A (72.28 +/- 29.18 mmHg) and Group C (94.28 +/- 20.46 mmHg) as well as in the right atrial pressure (p&lt;0.001) between Group C (4.5 mmHg) vs Groups A (2 mmHg) and B (2 mmHg) during ROSC time. Lactate levels were statistically significantly lower (p=0.035) in Group C (mean=0.92 +/- 0.07mmol/L) as compared to Group A (mean=1.13 +/- 0.1 mmol/L) and Group B (mean=1.08 +/- 0.07 mmol/L; p = 0.034) at 4h post-ROSC. Conclusion We provide preliminary evidence that ventilation with ETT with moderate leakage improves survival after 2h of ROSC, along with oxygenation and hemodynamic parameters, in a porcine model of neonatal asphyxia and resuscitation, compared to less leakage ETT

Continuous chest compressions with asynchronous ventilation improve survival in a neonatal swine model of asphyxial cardiac arrest

Background: Guidelines for neonatal resuscitation recommend a 3:1 compression to ventilation ratio. However, this recommendation is based on expert opinion and consensus rather than strong scientific evidence. Our primary aim was to assess whether continuous chest compressions with asynchronous ventilations would increase return of spontaneous circulation (ROSC) rate and survival compared to the 3:1 chest compression to ventilation ratio. Methods: This was a prospective, randomized, laboratory study. Twenty male Landrace-Large White pigs, aged 1–4 days with an average weight 1.650 ± 228.3 g were asphyxiated and left untreated until heart rate was less than 60 bpm or mean arterial pressure was below 15 mmHg. Animals were then randomly assigned to receive either continuous chest compressions with asynchronous ventilations (n = 10), or standard (3:1) chest compression to ventilation ratio (n = 10). Heart rate and arterial pressure were assessed every 30 s during cardiopulmonary resuscitation (CPR) until ROSC or asystole. All animals with ROSC were monitored for 4 h. Results: Coronary perfusion pressure (CPP) at 30 s of CPR was significantly higher in the experimental group (45.7 ± 16.9 vs. 21.8 ± 6 mmHg, p &amp;lt; 0.001) and remained significantly elevated throughout the experiment. End-tidal carbon dioxide (ETCO2) was also significantly higher in the experimental group throughout the experiment (23.4 ± 5.6 vs. 14.7 ± 5.9 mmHg, p &amp;lt; 0.001). ROSC was observed in six (60%) animals treated with 3:1 compression to ventilation ratio and nine (90%) animals treated with continuous chest compressions and asynchronous ventilation (p = 0.30). Time to ROSC was significantly lower in the experimental group (30 (30−30) vs. 60 (60–60) sec, p = 0.021). Of note, 7 (77.8%) animals in the experimental group and 1 (16.7%) animal in the control group achieved ROSC after 30 s (0.02). At 4 h, 2 (20%) animals survived in the control group compared to 7 (70%) animals in the experimental group (p = 0.022). Conclusion: Continuous chest compressions with asynchronous ventilations significantly improved CPP, ETCO2, time to ROSC, ROSC at 30 s and survival in a porcine model of neonatal resuscitation. © 2021 Elsevier Inc

Continuous chest compressions with asynchronous ventilation improve survival in a neonatal swine model of asphyxial cardiac arrest

Background: Guidelines for neonatal resuscitation recommend a 3:1 compression to ventilation ratio. However, this recommendation is based on expert opinion and consensus rather than strong scientific evidence. Our primary aim was to assess whether continuous chest compressions with asynchronous ventilations would increase return of spontaneous circulation (ROSC) rate and survival compared to the 3:1 chest compression to ventilation ratio. Methods: This was a prospective, randomized, laboratory study. Twenty male Landrace-Large White pigs, aged 1–4 days with an average weight 1.650 ± 228.3 g were asphyxiated and left untreated until heart rate was less than 60 bpm or mean arterial pressure was below 15 mmHg. Animals were then randomly assigned to receive either continuous chest compressions with asynchronous ventilations (n = 10), or standard (3:1) chest compression to ventilation ratio (n = 10). Heart rate and arterial pressure were assessed every 30 s during cardiopulmonary resuscitation (CPR) until ROSC or asystole. All animals with ROSC were monitored for 4 h. Results: Coronary perfusion pressure (CPP) at 30 s of CPR was significantly higher in the experimental group (45.7 ± 16.9 vs. 21.8 ± 6 mmHg, p &lt; 0.001) and remained significantly elevated throughout the experiment. End-tidal carbon dioxide (ETCO2) was also significantly higher in the experimental group throughout the experiment (23.4 ± 5.6 vs. 14.7 ± 5.9 mmHg, p &lt; 0.001). ROSC was observed in six (60%) animals treated with 3:1 compression to ventilation ratio and nine (90%) animals treated with continuous chest compressions and asynchronous ventilation (p = 0.30). Time to ROSC was significantly lower in the experimental group (30 (30−30) vs. 60 (60–60) sec, p = 0.021). Of note, 7 (77.8%) animals in the experimental group and 1 (16.7%) animal in the control group achieved ROSC after 30 s (0.02). At 4 h, 2 (20%) animals survived in the control group compared to 7 (70%) animals in the experimental group (p = 0.022). Conclusion: Continuous chest compressions with asynchronous ventilations significantly improved CPP, ETCO2, time to ROSC, ROSC at 30 s and survival in a porcine model of neonatal resuscitation. © 2021 Elsevier Inc