A Randomized, Controlled Animal Study: 21% or 100% Oxygen during Cardiopulmonary Resuscitation in Asphyxiated Infant Piglets

Background: During pediatric cardiopulmonary resuscitation (CPR), resuscitation guidelines recommend 100% oxygen (O₂); however, the most effective O₂ concentration for infants unknown. Aim: We aimed to determine if 21% O₂ during CPR with either chest compression (CC) during sustained inflation (SI) (CC + SI) or continuous chest compression with asynchronized ventilation (CCaV) will reduce time to return of spontaneous circulation (ROSC) compared to 100% O₂ in infant piglets with asphyxia-induced cardiac arrest. Methods: Piglets (20–23 days of age, weighing 6.2–10.2 kg) were anesthetized, intubated, instrumented, and exposed to asphyxia. Cardiac arrest was defined as mean arterial blood pressure < 25 mmHg with bradycardia. After cardiac arrest, piglets were randomized to CC + SI or CCaV with either 21% or 100% O₂ or the sham. Heart rate, arterial blood pressure, carotid blood flow, and respiratory parameters were continuously recorded. Main results: Baseline parameters, duration, and degree of asphyxiation were not different. Median (interquartile range) time to ROSC was 107 (90–440) and 140 (105–200) s with CC + SI 21% and 100% O₂, and 600 (50–600) and 600 (95–600) s with CCaV 21% and 100% O₂ (p = 0.27). Overall, six (86%) and six (86%) piglets with CC + SI 21% and 100% O₂, and three (43%) and three (43%) piglets achieved ROSC with CCaV 21% and 100% O₂ (p = 0.13). Conclusions: In infant piglets resuscitated with CC + SI, time to ROSC reduced and survival improved compared to CCaV. The use of 21% O₂ had similar time to ROSC, short-term survival, and hemodynamic recovery compared to 100% oxygen. Clinical studies comparing 21% with 100% O₂ during infant CPR are warranted.