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Neonatal resuscitation with continuous chest compressions and high frequency percussive ventilation in preterm lambs

Pediatric Research volume 95, pages 160–166 (2024)Cite this article

Abstract

Background

Cerebral oxygen delivery (cDO2) is low during chest compressions (CC). We hypothesized that gas exchange and cDO2 are better with continuous CC with high frequency percussive ventilation (CCC + HFPV) compared to conventional 3:1 compressions-to-ventilation (C:V) resuscitation during neonatal resuscitation in preterm lambs with cardiac arrest induced by umbilical cord compression.

Methods

Fourteen lambs in cardiac arrest were randomized to 3:1 C:V resuscitation (90CC + 30 breaths/min) per the Neonatal Resuscitation Program guidelines or CCC + HFPV (120CC + HFPV continuously). Intravenous epinephrine was given every 3 min until return of spontaneous circulation (ROSC).

Results

There was no difference in the incidence and time to ROSC between both groups. Median (IQR) PaCO2 was significantly lower with CCC + HFPV during CC, at ROSC and 15 min post-ROSC-[104 (99–112), 83 (77–99), and 43 (40–64)], respectively compared to 3:1 C:V-[149 (139–167), 153 (143–168), and 153 (138–178) mmHg. PaO2 and cDO2 were higher with CCC + HFPV during CC and at ROSC. PaO2 was similar 15 min post-ROSC with a lower FiO2 in the CCC + HFPV group 0.4 (0.4–0.5) vs. 1 (0.6–1).

Conclusion

In preterm lambs with perinatal cardiac-arrest, continuous chest compressions with HFPV does not improve ROSC but enhances gas exchange and increases cerebral oxygen delivery compared to 3:1 C:V during neonatal resuscitation.

Impact statement

  • Ventilation is the most important intervention in newborn resuscitation.

  • Currently recommended 3:1 compression-to-ventilation ratio is associated with hypercarbia and poor oxygen delivery to the brain.

  • Providing uninterrupted continuous chest compressions during high frequency percussive ventilation is feasible in a lamb model of perinatal cardiac arrest, and demonstrates improved gas exchange and oxygen delivery to the brain.

  • This is the first study in premature lambs evaluating high frequency percussive ventilation with asynchronous chest compressions and lays the groundwork for future clinical studies to optimize gas exchange and hemodynamics during chest compressions in newborns.

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Fig. 1: Picture of the TXP-5 ventilator and Phasitron next to a ruler in inches for comparison.
Fig. 2: Changes in preductal PaCO2 in CCC + HFPV group and 3:1 C:V group at baseline, after asphyxia, during chest compressions, at time of ROSC, and 15 min post-ROSC.
Fig. 3: Changes in preductal PaO2 and FiO2 in CCC + HFPV group and 3:1 C:V group at baseline, after asphyxia, during chest compressions, at time of ROSC, and 15 min post-ROSC.
Fig. 4: Changes in cerebral oxygen delivery in CCC + HFPV group and 3:1C:V group at baseline, after asphyxia, during chest compressions, at time of ROSC, and 15 min post-ROSC.

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Data availability

The datasets generated during and analyzed from the current study are available from the corresponding author on request.

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Acknowledgements

This research was funded by Children’s Miracle Network at University of California, Davis (S-CMNEG22).

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Authors and Affiliations

  1. Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento, CA, USA

    Evan Giusto, Deepika Sankaran, Houssam Joudi, Morgan Hardie, Lida Zeinali, Satyan Lakshminrusimha & Payam Vali

  2. D-5 Neonatal Units, Patient Care Services, University of California, Davis Health, Sacramento, CA, USA

    Evan Giusto

  3. Stem Cell Program, School of Medicine, University of California, Davis, Sacramento, CA, USA

    Amy Lesneski & Victoria Hammitt

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Contributions

Contributed to study design, study conduction, and data analysis: E.G, D.S., A.L., H.J., M.H., V.H., L.Z., S.L., P.V. Drafted and provided critique of manuscript: E.G., D.S., A.L., S.L., P.V. Final approval: E.G., D.S., S.L., P.V.

Corresponding author

Correspondence to Evan Giusto.

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Competing interests

The authors declare no conflicts of interest. S.L. is a member of the AAP-NRP steering committee. The views expressed in this article are his own and does not represent the official position of AAP or NRP. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

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Giusto, E., Sankaran, D., Lesneski, A. et al. Neonatal resuscitation with continuous chest compressions and high frequency percussive ventilation in preterm lambs. Pediatr Res 95, 160–166 (2024). https://doi.org/10.1038/s41390-023-02820-x

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