title: Prevalence of systemic air-embolism after prolonged cardiopulmonary resuscitation in newborns: A pilot study.
abstract: BACKGROUND
  Chest compressions (CC) during cardiopulmonary resuscitation (CPR) are the cornerstone of adult CPR protocols and are meant to restore circulation and improve outcome. Although adverse effects such as air-embolisms have been reported, these are rare and considered to be outweighed by beneficial effect. In newborns, however, the lung tissue is more fragile. Thus, the high intra-thoracic pressures resulting from CC may make the newborns more vulnerable for air-embolisms.
  
  
  OBJECTIVE
  We studied the postmortem prevalence of air-embolism in neonates that have received CPR.
  
  
  METHODS
  Prospective cohort analysis of newborns receiving CC during CPR. CPR was performed by trained staff according to ILCOR guidelines, in a tertiary hospital. Air-embolisms were sought after using CT/MRI and autopsy.
  
  
  RESULTS
  During a 61/2 year period (2007-2014), n = 56 newborns received CC. Newborns were resuscitated following severe perinatal hypoxia, or due to complications during NICU treatment. In n = 14 (25.0%) circulation could not be restored (mean CPR duration: 32.7 ± 15.2 min). Post-mortem CT/MRI was performed in n = 9, of whom n = 8 (88.9%) had air-embolisms. Autopsy was performed in n = 9. The air-embolisms could not be retraced on autopsy except for n = 1 patient. In patients with CPR resulting in restored circulation (n = 42), no CT or MRI was performed for comparison due to radiation and/or hemodynamic instability. Cerebral ultrasound could not identify or exclude air-embolisms in this subgroup.
  
  
  CONCLUSIONS
  Post-mortem CT after prolonged resuscitation showed a high prevalence of intravascular air-embolism. Autopsy was not suited to detect air-embolism. The clinical importance of air-embolisms on the lethal outcome needs further research.
authors.affiliation: Maxima Medical Centre, Dept. Neonatal ICU, Veldhoven, The Netherlands. Electronic address: Halbertsma@mmc.nl.
authors.forename: Feico J J
authors.initials: FJ
authors.lastname: Halbertsma
authors.affiliation: Maxima Medical Centre, Dept. Neonatal ICU, Veldhoven, The Netherlands.
authors.forename: Thilo
authors.initials: T
authors.lastname: Mohns
authors.affiliation: Maxima Medical Centre, Dept. Neonatal ICU, Veldhoven, The Netherlands.
authors.forename: Levinus A
authors.initials: LA
authors.lastname: Bok
authors.affiliation: Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Hendrik J
authors.initials: HJ
authors.lastname: Niemarkt
authors.affiliation: Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Boris W
authors.initials: BW
authors.lastname: Kramer
mesh_terms: D001238:Asphyxia Neonatorum / Q000628:therapy*; D001344:Autopsy / Q000379:methods / Q000706:statistics & numerical data; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D004618:Embolism, Air / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010865:Pilot Projects; D011312:Pressure / Q000009:adverse effects*; D015995:Prevalence; D011446:Prospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Air embolism; CPR complications; Chest compressions; Neonatal resuscitation