title: Myocardial perfusion and oxidative stress after 21% vs. 100% oxygen ventilation and uninterrupted chest compressions in severely asphyxiated piglets.
abstract: Despite the minimal evidence, neonatal resuscitation guidelines recommend using 100% oxygen when chest compressions (CC) are needed. Uninterrupted CC in adult cardiopulmonary resuscitation (CPR) may improve CPR hemodynamics. We aimed to examine 21% oxygen (air) vs. 100% oxygen in 3:1 CC:ventilation (C:V) CPR or continuous CC with asynchronous ventilation (CCaV) in asphyxiated newborn piglets following cardiac arrest.
  
  
  
  Piglets (1-3 days old) were progressively asphyxiated until cardiac arrest and randomized to 4 experimental groups (n=8 each): air and 3:1 C:V CPR, 100% oxygen and 3:1 C:V CPR, air and CCaV, or 100% oxygen and CCaV. Time to return of spontaneous circulation (ROSC), mortality, and clinical and biochemical parameters were compared between groups. We used echocardiography to measure left ventricular (LV) stroke volume at baseline, at 30min and 4h after ROSC. Left common carotid artery blood pressure was measured continuously.
  
  
  
  Time to ROSC (heart rate ≥100min(-1)) ranged from 75 to 592s and mortality 50-75%, with no differences between groups. Resuscitation with air was associated with higher LV stroke volume after ROSC and less myocardial oxidative stress compared to 100% oxygen groups. CCaV was associated with lower mean arterial blood pressure after ROSC and higher myocardial lactate than those of 3:1 C:V CPR.
  
  
  
  In neonatal asphyxia-induced cardiac arrest, using air during CC may reduce myocardial oxidative stress and improve cardiac function compared to 100% oxygen. Although overall recovery may be similar, CCaV may impair tissue perfusion compared to 3:1 C:V CPR.
authors.affiliation: Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada; Department of Pediatrics, University of Alberta, Edmonton, Canada; Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway. Electronic address: a.l.solevag@medisin.uio.no.
authors.forename: Anne Lee
authors.initials: AL
authors.lastname: Solevåg
authors.affiliation: Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada; Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Georg M
authors.initials: GM
authors.lastname: Schmölzer
authors.affiliation: Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada; Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Megan
authors.initials: M
authors.lastname: O'Reilly
authors.affiliation: Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada; Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Min
authors.initials: M
authors.lastname: Lu
authors.affiliation: Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada; Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Tze-Fun
authors.initials: TF
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Hornberger
authors.affiliation: Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Britt
authors.initials: B
authors.lastname: Nakstad
authors.affiliation: Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada; Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Po-Yin
authors.initials: PY
authors.lastname: Cheung
mesh_terms: D000818:Animals; D001237:Asphyxia; D016887:Cardiopulmonary Resuscitation; D004452:Echocardiography; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology*; D006336:Heart Massage; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology; D007231:Infant, Newborn; D008297:Male; D015428:Myocardial Reperfusion Injury / Q000209:etiology; D018384:Oxidative Stress / Q000502:physiology*; D010100:Oxygen / Q000627:therapeutic use*; D011897:Random Allocation; D012121:Respiration, Artificial / Q000379:methods*; D013552:Swine
chemical_list: D010100:Oxygen
keywords: Animals; Asphyxia neonatorum; Cardiopulmonary resuscitation; Heart massage; Newborn; Oxygen