The Effect of Asphyxia Arrest Duration on a Pediatric End-Tidal CO2-Guided Chest Compression Delivery Model

Overview

Journal Pediatr Crit Care Med

Specialty Pediatrics

Date 2019 Jun 1

PMID 31149967

Citations 6

Authors

Jennifer L Hamrick

Justin T Hamrick

Caitlin E OBrien

Michael Reyes

Polan T Santos

Sophie E Heitmiller

Ewa Kulikowicz

Jennifer K Lee

Sapna R Kudchadkar

Raymond C Koehler

Elizabeth A Hunt

Donald H Shaffner

Affiliations

Soon will be listed here.

Abstract

Objectives: To determine the effect of the duration of asphyxial arrest on the survival benefit previously seen with end-tidal CO2-guided chest compression delivery.

Design: Preclinical randomized controlled study.

Setting: University animal research laboratory.

Subjects: Two-week-old swine.

Interventions: After either 17 or 23 minutes of asphyxial arrest, animals were randomized to standard cardiopulmonary resuscitation or end-tidal CO2-guided chest compression delivery. Standard cardiopulmonary resuscitation was optimized by marker, monitor, and verbal feedback about compression rate, depth, and release. End-tidal CO2-guided delivery used adjustments to chest compression rate and depth to maximize end-tidal CO2 level without other feedback. Cardiopulmonary resuscitation for both groups proceeded from 10 minutes of basic life support to 10 minutes of advanced life support or return of spontaneous circulation.

Measurements And Main Results: After 17 minutes of asphyxial arrest, mean end-tidal CO2 during 10 minutes of cardiopulmonary resuscitation was 18 ± 9 torr in the standard group and 33 ± 15 torr in the end-tidal CO2 group (p = 0.004). The rate of return of spontaneous circulation was three of 14 (21%) in the standard group rate and nine of 14 (64%) in the end-tidal CO2 group (p = 0.05). After a 23-minute asphyxial arrest, neither end-tidal CO2 values (20 vs 26) nor return of spontaneous circulation rate (3/14 vs 1/14) differed between the standard and end-tidal CO2-guided groups.

Conclusions: Our previously observed survival benefit of end-tidal CO2-guided chest compression delivery after 20 minutes of asphyxial arrest was confirmed after 17 minutes of asphyxial arrest. The poor survival after 23 minutes of asphyxia shows that the benefit of end-tidal CO2-guided chest compression delivery is limited by severe asphyxia duration.

Citing Articles

Elevated serum neurologic biomarker profiles after cardiac arrest in a porcine model.

Senthil K, Ranganathan A, Piel S, Hefti M, Reeder R, Kirschen M Resusc Plus. 2024; 19:100726.

PMID: 39149222 PMC: 11325790. DOI: 10.1016/j.resplu.2024.100726.

Association of diastolic blood pressure with coronary perfusion pressure during resuscitation in pediatric swine.

Sorcher J, Santos P, Adams S, Kulikowicz E, Vaidya D, Lee J Pediatr Res. 2024; .

PMID: 39009765 DOI: 10.1038/s41390-024-03308-y.

Use of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swine.

OBrien C, Santos P, Kulikowicz E, Adams S, Lee J, Hunt E Resusc Plus. 2021; 8:100174.

PMID: 34820656 PMC: 8600153. DOI: 10.1016/j.resplu.2021.100174.

Focused echocardiography, end-tidal carbon dioxide, arterial blood pressure or near-infrared spectroscopy monitoring during paediatric cardiopulmonary resuscitation: A scoping review.

Kool M, Atkins D, Van de Voorde P, Maconochie I, Scholefield B Resusc Plus. 2021; 6:100109.

PMID: 34228034 PMC: 8244529. DOI: 10.1016/j.resplu.2021.100109.

The use of pressure-controlled mechanical ventilation in a swine model of intraoperative pediatric cardiac arrest.

Lapid F, OBrien C, Kudchadkar S, Lee J, Hunt E, Koehler R Paediatr Anaesth. 2020; 30(4):462-468.

PMID: 31900987 PMC: 7182496. DOI: 10.1111/pan.13820.

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