Assessing the influence of abdominal compression on time to return of circulation during resuscitation of asphyxiated newborn lambs: a randomised preclinical study.

Autor:	Polglase GR; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia., Hwang C; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia., Blank DA; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.; Department of Paediatrics, Monash University, Clayton, Victoria, Australia.; Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia., Badurdeen S; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.; Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia., Crossley KJ; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia., Kluckow M; Department of Neonatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia., Gill AW; Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia., Camm E; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia., Galinsky R; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia., Brian Y; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia., Hooper SB; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia., Roberts CT; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia calum.roberts@monash.edu.; Department of Paediatrics, Monash University, Clayton, Victoria, Australia.; Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	Archives of disease in childhood. Fetal and neonatal edition [Arch Dis Child Fetal Neonatal Ed] 2024 Jun 19; Vol. 109 (4), pp. 405-411. Date of Electronic Publication: 2024 Jun 19.
DOI:	10.1136/archdischild-2023-326047
Abstrakt:	Objective: During neonatal resuscitation, the return of spontaneous circulation (ROSC) can be achieved using epinephrine which optimises coronary perfusion by increasing diastolic pressure. Abdominal compression (AC) applied during resuscitation could potentially increase diastolic pressure and therefore help achieve ROSC. We assessed the use of AC during resuscitation of asystolic newborn lambs, with and without epinephrine. Methods: Near-term fetal lambs were instrumented for physiological monitoring and after delivery, asphyxiated until asystole. Resuscitation was commenced with ventilation followed by chest compressions. Lambs were randomly allocated to: intravenous epinephrine (20 µg/kg, n=9), intravenous epinephrine+continuous AC (n=8), intravenous saline placebo (5 mL/kg, n=6) and intravenous saline+AC (n=9). After three allocated treatment doses, rescue intravenous epinephrine was administered if ROSC had not occurred. Time to achieve ROSC was the primary outcome. Lambs achieving ROSC were ventilated and monitored for 60 min before euthanasia. Brain histology was assessed for micro-haemorrhage. Results: Use of AC did not influence mean time to achieve ROSC (epinephrine lambs 177 s vs epinephrine+AC lambs 179 s, saline lambs 602 s vs saline+AC lambs 585 s) or rate of ROSC (nine of nine lambs, eight of eight lambs, one of six lambs and two of eight lambs, respectively). Application of AC was associated with higher diastolic blood pressure (mean value >10 mm Hg), mean and systolic blood pressure and carotid blood flow during resuscitation. Cortex and deep grey matter micro-haemorrhage was more frequent in AC lambs. Conclusion: Use of AC during resuscitation increased diastolic blood pressure, but did not impact time to ROSC. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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