Effects of airway management and tidal volume feedback ventilation during pediatric resuscitation in piglets with asphyxial cardiac arrest

AbstractTo compare the effect on the recovery of spontaneous circulation (ROSC) of early endotracheal intubation (ETI) versus bag-mask ventilation (BMV), and expiratory real-time tidal volume (VTe) feedback (TVF) ventilation versus without feedback or standard ventilation (SV) in a pediatric animal model of asphyxial cardiac arrest. Piglets were randomized into five groups: 1: ETI and TVF ventilation (10 ml/kg); 2: ETI and TVF (7 ml/kg); 3: ETI and SV; 4: BMV and TVF (10 ml/kg) and 5: BMV and SV. Thirty breaths-per-minute guided by metronome were given. ROSC, pCO2, pO2, EtCO2 and VTe were compared among groups. Seventy-nine piglets (11.3 ± 1.2 kg) were included. Twenty-six (32.9%) achieved ROSC. Survival was non-significantly higher in ETI (40.4%) than BMV groups (21.9%), p = 0.08. No differences in ROSC were found between TVF and SV groups (30.0% versus 34.7%, p = 0.67). ETI groups presented lower pCO2, and higher pO2, EtCO2 and VTe than BMV groups (p < 0.05). VTe was lower in TVF than in SV groups and in BMV than in ETI groups (p < 0.05). Groups 1 and 3 showed higher pO2 and lower pCO2 over time, although with hyperventilation values (pCO2 < 35 mmHg). ETI groups had non significantly higher survival rate than BMV groups. Compared to BMV groups, ETI groups achieved better oxygenation and ventilation parameters. VTe was lower in both TVF and BMV groups. Hyperventilation was observed in intubated animals with SV and with 10 ml/kg VTF.

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USEFULNESS OF BICARBONATE DURING RESUSCITATION IN A PEDIATRIC ANIMAL MODEL OF ASPHYXIAL CARDIAC ARREST

10.26226/morressier.57d034d0d462b8029238348b ◽

2016 ◽

Author(s):

JAVIER URBANO

Keyword(s):

Animal Model ◽

Cardiac Arrest ◽

Asphyxial Cardiac Arrest

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Faculty Opinions recommendation of Chest compressions versus ventilation plus chest compressions in a pediatric asphyxial cardiac arrest animal model.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.2838957.2504055 ◽

2010 ◽

Author(s):

Gideon Paret ◽

Marianne Nellis

Keyword(s):

Animal Model ◽

Cardiac Arrest ◽

Chest Compressions ◽

Asphyxial Cardiac Arrest

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Abstract 150: Effect of Amplitude Spectral Area on Termination of Fibrillation and Outcomes in Pediatric Cardiac Arrest

Circulation ◽

10.1161/circ.142.suppl_4.150 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Tia Raymond ◽

Sandeep Pandit ◽

Heather M Griffis ◽

Xuemei Zhang ◽

Richard Hanna ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Median Number ◽

Spontaneous Circulation ◽

Primary Endpoints ◽

Pediatric Resuscitation ◽

Spectral Area ◽

Secondary Endpoints ◽

Cardiac Illness ◽

Illness Category

Introduction: Amplitude spectral area (AMSA) predicts termination of fibrillation (TOF) with return of spontaneous circulation (ROSC) and hospital survival in adults, but has not been studied during pediatric cardiac arrest (pCA). Hypothesis: We characterized AMSA during pCA from a pediatric resuscitation quality (pediRES-Q) collaborative and hypothesized that AMSA would be associated with TOF and ROSC. Methods: Children <18 years of age with pCA and VF were studied. AMSA was measured for 2 seconds prior to each shock and also averaged for each subject (AMSA-avg). TOF was defined as termination of VF 10 secs after defibrillation (DF) to any rhythm other than VF. ROSC was defined as >20 mins without chest compressions. Univariate and multivariable logistic regression analyses controlling for weight, current, and illness category (cardiac vs non-cardiac) were performed. Primary endpoints were TOF and ROSC without ECMO. Secondary endpoints were 24-hr survival and survival to hospital discharge. Results: Between 2015-2019, 50 children from 14 hospitals (median age 3.7 years [IQR 0.6, 13.1]; median weight 16.3 kgs [IQR 6.9, 37.2]; 46% male; 73% cardiac illness category) were identified. IHCA occurred in 47 children and OHCA in 3 children. We analyzed 111 shocks with median number of DFs 1.0 [IQR 1.0, 3.0], median DF energy dose 3.27 J/kg [IQR 2.65,5.01], median DF current 0.64 A/kg [IQR 0.38,0.96], median AMSA 12.21 [IQR 7.17,17.03], and median AMSA-avg 14.6 [IQR 8.6,19.2]. TOF was achieved in 72 DFs (65%), ROSC without ECMO in 31 (62%), ROC with ECMO in 11 (22%), 24-hr survival in 40 (80%), and survival to hospital discharge in 26 (52%). Weight (OR 0.91 [0.84, 0.99] P=0.025) and DF current (OR 1.44 [0.97, 2.2] P=0.07), but not AMSA, were significantly associated with TOF for the first shock. Controlling for DF current and illness category, there was a significant association between AMSA-avg (OR 1.11 [1.0, 1.24] P=0.044) and ROSC without ECMO. There was no significant association between AMSA-avg and 24-hr survival or survival to hospital discharge. Conclusions: In pediatric patients, TOF was associated with weight and DF current, but not AMSA, whereas AMSA-avg was associated with ROSC without ECMO, but not 24-hr survival or survival to hospital discharge.

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Comparison between manual and mechanical chest compressions during resuscitation in a pediatric animal model of asphyxial cardiac arrest

PLoS ONE ◽

10.1371/journal.pone.0188846 ◽

2017 ◽

Vol 12 (11) ◽

pp. e0188846 ◽

Cited By ~ 3

Author(s):

Jorge López ◽

Sarah N. Fernández ◽

Rafael González ◽

María J. Solana ◽

Javier Urbano ◽

...

Keyword(s):

Animal Model ◽

Cardiac Arrest ◽

Chest Compressions ◽

Asphyxial Cardiac Arrest

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D-Cycloserine 24 and 48 Hours after Asphyxial Cardiac Arrest has No Effect on Hippocampal CA1 Neuropathology

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2014.135 ◽

2014 ◽

Vol 34 (10) ◽

pp. e1-e8 ◽

Cited By ~ 1

Author(s):

Vélvá M Combs ◽

Heather D Crispell ◽

Kelly L Drew

Keyword(s):

Cardiac Arrest ◽

Closed Head Injury ◽

Spontaneous Circulation ◽

Neurological Deficits ◽

Sprague Dawley ◽

Cell Counts ◽

Sprague Dawley Rats ◽

Hippocampal Ca1 ◽

Asphyxial Cardiac Arrest ◽

Stimulation Of

Stimulation of N-methyl-D-aspartate receptors (NMDAR) contributes to regenerative neuroplasticity following the initial excitotoxic insult during cerebral ischemia. Stimulation of NMDAR with the partial NMDAR agonist D-cycloserine (DCS) improves outcome and restores hippocampal synaptic plasticity in models of closed head injury. We thus hypothesized that DCS would improve outcome following restoration of spontaneous circulation (ROSC) from cardiac arrest (CA). DCS (10 mg/kg, IP) was administered to Sprague-Dawley rats (male, 250–330 g; 63–84 days old) 24 and 48 hours after 6 or 8 minutes of asphyxial CA. Heart rate and blood pressure declined similarly in all groups. Animals showed neurological deficits after 6 and 8 minutes CA ( P < 0.05, Tukey) and these deficits recovered more quickly after 6 minutes than after 8 minutes of CA. CA decreased the number of healthy neurons within CA1 with no difference between 6 and 8 minutes duration of CA (180.8 ± 27.6 (naïve, n = 5) versus 46.3 ± 33.8 (all CA groups, n = 27) neurons per mm CA1). DCS had no effect on neurological deficits or CA1 hippocampal cell counts ( P > 0.05, Tukey).

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Humerus intraosseous administration of epinephrine in normovolemic and hypovolemic porcine model

American Journal of Disaster Medicine ◽

10.5055/ajdm.2018.0291 ◽

2018 ◽

Vol 13 (2) ◽

pp. 97-106

Author(s):

LTC Robert P. Long, II, PhD, CRNA ◽

LTC Stephanie M. Gardner, DNP, CRNA ◽

James Burgert, DNAP, CRNA ◽

LTC Craig A. Koeller, DVM, DACLAM, AFRL ◽

LTC Joseph O’Sullivan, PhD, CRNA ◽

...

Keyword(s):

Cardiac Arrest ◽

Blood Volume ◽

Maximum Concentration ◽

Porcine Model ◽

Spontaneous Circulation ◽

Rate Of Return ◽

Blood Samples ◽

Return Of Spontaneous Circulation ◽

Mean Concentration ◽

Over Time

Objective: Compare the maximum concentration (Cmax), time to maximum concentration (Tmax), mean concentration, rate of return of spontaneous circulation (ROSC), time to ROSC, and odds of ROSC when epinephrine is administered by humerus intraosseous (HIO) compared to intravenous (IV) routes in both a hypovolemic and normovolemic cardiac arrest model.Design: Prospective, between subjects, randomized experimental study.Setting: TriService Facility.Subjects: Twenty-eight adult Yorkshire Swine were randomly assigned to four groups: HIO normovolemia; HIO hypovolemia; IV normovolemia; and IV hypovolemia.Intervention: Swine were anesthetized. The hypovolemic group was exsanguinated 31 percent of their blood volume. Subjects were placed into arrest. After 2 minutes, cardiopulmonary resuscitation (CPR) was initiated. After another 2 minutes, 1 mg epinephrine was given by IV or HIO routes; blood samples were collected over 4 minutes. Hypovolemic groups received 500 mL of 5 percent albumin following blood sampling. CPR continued until ROSC or for 30 minutes.Main outcome measures: ROSC, time to ROSC, Cmax, Tmax, mean concentrations over time, odds of ROSC.Results: Cmax was significantly higher, the Tmax, and the time to ROSC were significantly faster in the HIO normovolemic compared to the HIO hypovolemic group (p 0.05). All seven in the HIO normovolemic group achieved ROSC compared to three of the HIO hypovolemic group. Odds of ROSC were 19.2 times greater in the HIO normovolemic compared the HIO hypovolemic group.Conclusion: The HIO is an effective route in a normovolemic model. However, the findings indicate that sufficient blood volume is essential for ROSC in a hypovolemic scenario.

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Comparison between Pediatric-Sized and Adult-Sized Bag-Valve-Mask Ventilation for Achieving Appropriate Tidal Volume in Simulated Adult Out-of-Hospital Cardiac Arrest in a Moving Ambulance

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.09.10408 ◽

2021 ◽

Vol 104 (9) ◽

pp. 1404-1410

Keyword(s):

Cardiac Arrest ◽

Tidal Volume ◽

Crossover Trial ◽

Medical Training ◽

Emergency Medical Technicians ◽

Mask Ventilation ◽

Chest Compressions ◽

Randomized Crossover Trial ◽

The Mean ◽

Hospital Cardiac Arrest

Background: Previous studies proposed that ventilation with pediatric-sized bag-valve-mask (BVM) ventilation resulted in more appropriate tidal volume (Vt) in adult patients than adult-sized BVM ventilation. However, those studies were conducted in stationary, non-moving environment. The authors hypothesized that the result of BVM ventilation in this treatment setting may be different when the investigation was conducted in a moving ambulance. Objective: To compare pediatric-sized and adult-sized BVM ventilation for achieving appropriate Vt in simulated adult out-of-hospital cardiac arrest (OHCA) in a moving ambulance. Materials and Methods: The present study was a randomized crossover trial. Registered nurses (RNs) and basic emergency medical technicians (EMT-Bs) were recruited to perform resuscitation ventilation on a medical training manikin. All participants performed both the pediatric-sized at 500 cc, and the adult-sized at 1,600 cc, BVM ventilation during 30 to 2 chest compressions to ventilation ratio during simulated OHCA in a moving ambulance. Adult-sized mask was used for both scenarios. The manikin was ventilated for 10 minutes during each scenario. The percentage of appropriate Vt was compared between scenarios. The percentages of low Vt at less than 400 cc and high Vt at more than 600 cc between groups were also evaluated. Results: Fifty-two volunteers with 57.7% RNs and 42.3% EMT-Bs were included. Of those 52 volunteers, 44 had less than five years of pre-hospital ventilation experience. The mean Vt was 239.0 cc and 444.5 cc in the pediatric-sized and the adult-sized BVM groups, respectively (p<0.001). Low Vt was observed in 100% of pediatric-sized BVM ventilation. In the adult-sized ventilation group, 52.1±25.6% had appropriate Vt, 11.4±18.6% had high Vt, and 36.5±29.1% had low Vt (p<0.001). Conclusion: A comparison between pediatric-sized and adult-sized BVM ventilation in simulated adult OHCA in a moving ambulance demonstrated the superiority of the adult-sized BVM over the pediatric-sized BVM for achieving appropriate Vt in adult OHCA. Keywords: Bag-valve-mask ventilation; Tidal volume; Out-of-hospital cardiac arrest; Ambulance

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Abstract 111: Age-Dependent Trends in Survival After Adult In-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.111 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Sebastian Wiberg ◽

Mathias J Holmberg ◽

Michael Donnino ◽

Jesper Kjaergaard ◽

Christian Hassager ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Neurological Outcome ◽

Survival Rates ◽

Age Groups ◽

Spontaneous Circulation ◽

Good Neurological Outcome ◽

Absolute Increase ◽

Hospital Cardiac Arrest ◽

Over Time

Background: While survival after in-hospital cardiac arrest (IHCA) has improved in recent years, it remains unknown whether this trend primarily applies to younger IHCA victims or extends to older patients as well. The aim of this study was to assess trends in survival to hospital discharge after adult IHCA across age groups from 2000 to 2016. Methods: This is an observational study of IHCA patients included in the Get With The Guidelines®-Resuscitation registry between January 2000 and December 2016. The primary outcome was survival to hospital discharge, while secondary outcomes included rates of return of spontaneous circulation (ROSC) and neurological outcome at discharge. Patients were stratified into five age groups: < 50 years, 50-59 years, 60-69 years, 70-79 years, and ≥80 years. Generalized linear regression was used to obtain absolute survival rates over time. Analyses of interaction were included to assess differences in survival trends between age groups. Results: A total of 234,767 IHCA patients were included for the analyses. The absolute increase in survival per calendar year was 0.8% (95%CI 0.7 - 1.0%, p < 0.001) for patients younger than 50 years, 0.6% (95%CI 0.4 - 0.7%, p < 0.001) for patients between 50 and 59 years, 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients between 60 and 69 years, 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients between 70 and 79 years, and 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients older than 80 years. Further, a significant increase in both rates of ROSC and survival with a good neurological outcome was seen for all age groups. In both unadjusted and adjusted analyses of survival, we observed a significant interaction between calendar year and age group ( p < 0.001), indicating that the rate of improvement in survival over time was significantly different between age groups. Conclusions: For patients with IHCA, survival to discharge, ROSC, and survival to discharge with a good neurological outcome have improved significantly from 2000 to 2016 for all age groups.

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