Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs
Abstract
:1. Introduction
2. Methods
2.1. Instrumentation in Utero
2.2. Asphyxial Cardiac Arrest and Resuscitation
- Group 1: 100% O2 CC—Gradual wean: Inspired oxygen was increased to 100% during CC and resuscitation was continued per AAP-NRP guidelines. Following ROSC, attempts were made to adjust inspired oxygen down from 100% O2 by 5–10% every 30 sec to achieve preductal SpO2 per NRP guidelines. After the first 10 min, we targeted 85–95% SpO2 in lambs that achieved ROSC during the first 30 min after ROSC, and 90–95% beyond 30 min after ROSC until 60 min for all the study lambs.
- Group 2: 100% O2 CC—Abrupt wean: Inspired oxygen was increased to 100% during CC, and resuscitation was continued per NRP. After ROSC, the inspired oxygen was rapidly decreased to 21% and attempts were made to adjust inspired oxygen up by 5–10% every 30 sec to maintain preductal SpO2 as described above.
- Group 3: 21% O2 CC: Inspired oxygen of 21% was administered during chest compressions. Following ROSC, inspired oxygen was titrated up by 5–10% every 30 sec to achieve preductal SpO2 as described above.
2.3. Primary and Secondary Outcomes
2.4. Sample Size Calculation
2.5. Data Collection and Analysis
3. Results
3.1. Hemodynamic and Arterial Blood Gas Parameters during Chest Compressions and after ROSC
3.2. Comparison of Markers of Oxidative Stress in Plasma and Brain Tissue
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameter | 100% O2 CC—Gradual Wean (n = 7) | 100% O2 CC—Abrupt Wean (n = 6) | 21% O2 CC (n = 6) |
---|---|---|---|
Weight (kg) | 3.5 ± 0.6 | 3.6 ± 0.6 | 3.7 ± 0.6 |
Gestational Age (days) | 140 ± 1.5 | 139.7 ± 0.5 | 139.7 ± 1.4 |
Sex (F:M) | 4:3 | 5:1 | 5:1 |
Hemoglobin, g/dL | 12.0 ± 1.4 | 11.4 ± 1.0 | 13.4 ± 2 |
pH | 7.24 ± 0.10 | 7.18 ± 0.08 | 7.19 ± 0.10 |
PaCO2 (mm Hg) | 66 ± 14 | 71 ± 11 | 76 ± 16 |
PaO2 (mm Hg) | 22 ± 6 | 25 ± 3 | 20 ± 8 |
Cerebral oxygen delivery (mL/kg/min) | 3.0 ± 1.3 | 2.9 ± 0.7 | 2.7 ± 1.1 |
Lactate (mmol/L) | 3.5 ± 2.2 | 2.5 ± 1.7 | 3.1 ± 2.6 |
Mean Carotid Artery Blood Flow (mL/kg/min) | 31.3 ± 8.0 | 30.1 ± 6.4 | 29.7 ± 9.0 |
Duration of Asphyxia until Asystole (min) | 12.5 ± 2.9 | 15.1 ± 2.3 | 16.5 ± 4.4 |
Incidence of ROSC n (%) | 7 (100) | 6 (100) | 5 (83.3) |
Number of epinephrine doses n (ROSC or not) | 1 dose in 7 lambs (ROSC) | 1 dose in 6 lambs (ROSC) | 1 dose in 5 lambs ROSC) 4 doses in 1 lamb (ROSC followed by rearrest) |
Parameter | 100% O2 CC—Gradual Wean (n = 7) | 100% O2 CC—Abrupt Wean (n = 6) | 21% O2 CC (n = 6) |
---|---|---|---|
PaO2 (mm Hg) | 18.5 ± 5.5 | 13.7 ± 11.0 | 10.7 ± 4.3 |
Mean Carotid Artery Blood Flow (QCA, mL/kg/min) | 3.1 ± 0.9 | 3.6 ± 1.8 | 2.8 ± 0.8 |
Cerebral oxygen delivery (mL/kg/min) | 0.07 ± 0.07 | 0.08 ± 0.07 | 0.06 ± 0.02 |
Parameter | 100% O2 CC—Gradual Wean (n = 7) | 100% O2 CC—Abrupt Wean (n = 6) | 21% O2 CC (n = 6) |
---|---|---|---|
Plasma markers | |||
Hypoxanthine/xanthine ratio Fetal Baseline | 26 ± 16 | 26 ± 14 | 17 ± 12 |
5 min after ROSC | 40 * ± 8 | 25 ± 6 | 24 ± 10 |
10 min after ROSC | 31 ± 16 | 28 ± 15 | 24 ± 8 |
Methionine sulfoxide/methionine ratio | |||
Fetal baseline | 5.5 ± 1.5 | 5.2 ± 0.1 | 5.4 ± 1.2 |
5 min after ROSC | 6.7 ± 1.2 | 5.5 ± 1.1 | 5.8 ± 1.6 |
10 min after ROSC | 6.6 ± 2.0 | 8.7 ± 1.0 | 7.6 ± 2.5 |
Lactic acid (×105) | |||
Fetal baseline | 8.7 ± 0.9 | 8.5 ± 2.2 | 13.9 ± 11.4 |
5 min after ROSC | 39.4 ± 5.2 | 29.6 ± 9.4 | 32.4 ± 8.4 |
10 min after ROSC | 37.5 ± 7.5 | 33.2 ± 2.6 | 30.6 ± 12.3 |
Brain markers | |||
Brain hypoxanthine/xanthine ratio | 24.2 ± 35.2 | 9.2 ± 1.9 | 10.6 ± 2.1 |
Brain methionine sulfoxide/methionine ratio | 2.2 ± 1.1 | 1.3 ± 0.1 | 1.2 ± 0.3 |
Brain lactic acid (×105) | 7.3 ± 1.7 | 6.3 ± 0.7 | 9.3 * ± 2 |
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Sankaran, D.; Giusto, E.M.; Lesneski, A.L.; Hardie, M.E.; Joudi, H.M.; Lane, E.C.A.; Hammitt, V.L.; Tully, K.C.; Vali, P.; Lakshminrusimha, S. Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs. Children 2023, 10, 575. https://doi.org/10.3390/children10030575
Sankaran D, Giusto EM, Lesneski AL, Hardie ME, Joudi HM, Lane ECA, Hammitt VL, Tully KC, Vali P, Lakshminrusimha S. Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs. Children. 2023; 10(3):575. https://doi.org/10.3390/children10030575
Chicago/Turabian StyleSankaran, Deepika, Evan M. Giusto, Amy L. Lesneski, Morgan E. Hardie, Houssam M. Joudi, Emily C. A. Lane, Victoria L. Hammitt, Kirstie C. Tully, Payam Vali, and Satyan Lakshminrusimha. 2023. "Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs" Children 10, no. 3: 575. https://doi.org/10.3390/children10030575