Pediatric Resident, PhD Student Medical University of Graz Medical University of Graz Graz, Austria
Background: Neonatal chest compression should be performed to a 1/3 anterior-posterior chest diameter depth, however, the optimal AP depth is unknown.
Objective: To examine the optimal anterior-posterior depth, which will reduce the time to return of spontaneous circulation and improve survival during chest compressions. Asphyxiated neonatal piglets receiving chest compression resuscitated with a 40% anterior-posterior chest depth compared to 33%, 25%, or 12.5% will have a reduced time to return of spontaneous circulation and improved survival.
Design/Methods: Newborn piglets (n=8/group) were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by asphyxia and cardiac arrest. Piglets were randomly allocated to four intervention groups (“anterior-posterior 12.5% depth”, “anterior-posterior 25% depth”, “anterior-posterior 33% depth” or “anterior-posterior 40% depth”). Chest compressions were performed using an automated chest compression machine with a rate of 90/min. Haemodynamic, respiratory parameters, applied compression force and chest compression depth were continuously measured.
Results: Median(IQR) time to return of spontaneous circulation was 600(600-600), 135(90-589), 85(71-158)*, 116(63-173)*sec for 12.5%, 25%, 33%, and 40% depth groups, respectively (*p<0.001 vs. 12.5%). Piglets achieved return of spontaneous circulation 0(0%), 6(75%), 7(88%), and 7(88%) in the 12.5%, 25%, 33%, and 40% AP depth groups, respectively. Arterial blood pressure, central venous pressure, carotid blood flow, applied compression force, tidal volume, and minute ventilation increased with greater anterior-posterior chest depth during chest compression. Conclusion(s): Time to return of spontaneous circulation and survival was similar between 25%, 33%, and 40% anterior-posterior depth, while 12.5% anterior-posterior depth did not result in return of spontaneous circulation or survival. Haemodynamic and respiratory parameters improved with greater anterior-posterior depth suggesting improved organ perfusion and oxygen delivery with 33-40% anterior-posterior depth.
Authors/Institutions: Marlies Bruckner, Medical University of Graz, Graz, Styria, Austria; Seung Yeun Kim, Eulji University, Edmonton, Alberta, Canada; Gyuhong Shim, Inje University Sanggye Paik Hospital, Edmonton, Alberta, Canada; Mattias Neset, University of Alberta, Edmonton, Alberta, Canada; Catalina Garcia-Hidalgo, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada; Tze-Fun Lee, University of Alberta, Edmonton, Alberta, Canada; Megan O'Reilly, University of Alberta, Edmonton, Alberta, Canada; Po-Yin Cheung, University of Alberta, Edmonton, Alberta, Canada; Georg Schmolzer, University of Alberta, Edmonton, Alberta, Canada
.jpg "Marlies Bruckner, MD photo")