title: Effect of Different Respiratory Modes on Return of Spontaneous Circulation in a Newborn Piglet Model of Hypoxic Cardiac Arrest.
abstract: BACKGROUND
  There are no clear evidence-based recommendations on the use of different techniques of respiratory support and chest compressions (CC) during neonatal cardiopulmonary resuscitation (CPR).
  
  
  OBJECTIVE
  To determine the effects of different respiratory support strategies along with CC representing clinical practice on the return of spontaneous circulation (ROSC) in hypoxic newborn piglets with cardiac arrest. We hypothesized that use of a T-piece resuscitator (TPR) providing positive end-expiratory pressure (PEEP) reduces time to ROSC as compared to a self-inflating bag (SIB) without PEEP. Furthermore, we explored the effects of a ventilator providing inflations without synchrony to CC.
  
  
  METHODS
  Thirty-three newborn piglets were exposed to hypoxia until asystole occurred and randomized into three groups and resuscitated according to ILCOR guidelines: group 1 = TPR [peak inspiratory pressure (PIP)/PEEP of 25/5 cm H2O, rate 30/min], inflations interposed between CC (3:1 ratio); group 2 = SIB (PIP of 25 cm H2O without PEEP, rate 30/min), inflations interposed between CC (3:1 ratio), and group 3 = ventilator (PIP/PEEP of 25/5 cm H2O, rate 30/min), CC were applied with a rate of 120/min without synchrony to inflations. Animals were supported for 120 min after ROSC. Primary outcome was time to ROSC.
  
  
  RESULTS
  All animals achieved ROSC. We found no significant difference in time to ROSC between groups [median (IQR); TPR: 150 s (150-210); SIB: 150 s (120-180); ventilator: 180 s (150-345)]. There was no difference in use of epinephrine, in blood gases or hemodynamic parameters during the 120-min observation time after ROSC.
  
  
  CONCLUSIONS
  We found no significant effect of different respiratory support strategies during CPR on ROSC.
authors.affiliation: Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Mendler
authors.forename: Claudia
authors.initials: C
authors.lastname: Weber
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Hassan
authors.forename: Li
authors.initials: L
authors.lastname: Huang
authors.forename: Markus
authors.initials: M
authors.lastname: Waitz
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mayer
authors.forename: Helmut D
authors.initials: HD
authors.lastname: Hummler
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001784:Blood Gas Analysis; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004195:Disease Models, Animal; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage; D006439:Hemodynamics; D000860:Hypoxia / Q000503:physiopathology; D007327:Insufflation / Q000379:methods; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D011897:Random Allocation; D013552:Swine; D012122:Ventilators, Mechanical
chemical_list: D004837:Epinephrine