Hemodynamic Differences in Recovery Following Chest Compression with Asynchronous Ventilation Using Chest Compression Rates of 90/min, 100/min, or 120/min in a Porcine Model of Neonatal Asphyxia

• Author / Creator

  Patel, Sparsh

• Extensive neonatal resuscitation that involves chest compressions is an uncommon event impacting approximately 0.1% of term newborns, and up to 15% of preterm newborns. Despite best resuscitation efforts birth asphyxia results in approximately one million deaths annually worldwide. Neonatal resuscitation research is still considered to be a field in its infancy when it comes to optimizing extensive resuscitation efforts. This is further complicated by the infrequent occurrence of extensive neonatal resuscitation, making it difficult to conduct rigorous clinical studies. However, optimizing neonatal resuscitation is an urgent issue as current extensive resuscitation practices are associated with poor survival and morbidity. Animal models make up the primary body of scientific knowledge when it comes to optimizing chest compression techniques. To this extent, the contents of this thesis explore whether continuous chest compressions with asynchronous ventilation (CCaV) with varying rates of chest compressions reduces the time to return of spontaneous circulation (ROSC) using a porcine model of neonatal asphyxia induced cardiac arrest. We hypothesize that CCaV with 120 CC/min will have reduced time to ROSC compared to CCaV with 100 CC/min or 90 CC/min.

  Thirty piglets of age 24-72h were surgically instrumented and allowed to recover to a stable baseline following surgery. Piglets in the intervention group were exposed to 30min of hypoxia followed by asphyxia until cardiac arrest, piglets in the sham-operated (n=6) group were not. Intervention piglets were randomized to receive CCaV with either 90 CC/min (n=8), 100 CC/min (n=8), or 120 CC/min (n=8) until ROSC or a maximum of 12min. Piglets that achieved ROSC were allowed to recover for 4h, after which, cerebral cortical tissues were harvested for bioassays.
  
  Time to ROSC was similar in all intervention groups (120s, 90s, and 90s for CCaV+120, CCaV+100, and CCaV+90 respectively, p=0.93). The number of piglets achieving ROSC (p=0.83), and survival to 4h after ROSC (p=0.50) was also similar across intervention groups. However, regional hemodynamic recovery at the end of experiment was significantly worse in CCaV with 90 CC/min and 100 CC/min compared to CCaV with 120 CC/min. A similar trend was observed with pro-inflammatory markers interleukin(IL)-1β, IL-6, and lactate in the frontoparietal cortex. Where CCaV with 90 CC/min and 100 CC/min had significantly worse cortical inflammatory and injury markers compared to CCaV with 120 CC/min.
  

• Subjects / Keywords

  • asphyxia
  • neonatal resuscitation
  • neonatal
  • hypoxia
  • hemodynamics
  • compression rate

• Graduation date

  Spring 2020

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-agkr-vq70

• License

  Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.