A Randomized, Controlled Animal Study: 21% or 100% Oxygen during Cardiopulmonary Resuscitation in Asphyxiated Infant Piglets
Abstract
:1. Introduction
2. Methods
2.1. Inclusion and Exclusion Criteria
2.2. Randomization
2.3. Sample Size and Power Estimates
2.4. Blinding
2.5. Animal Preparation
2.6. Hemodynamic Parameters
2.7. Respiratory Parameters
2.8. Cerebral Perfusion
2.9. Experimental Protocol
3. Data Collection and Analysis
4. Results
4.1. Resuscitation and Primary Outcome
4.2. Respiratory and Hemodynamic Parameters
4.3. Injury Markers
5. Discussion
6. Limitations
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
A 140-character Tweet
Abbreviations
CC | Chest compression |
CPR | Cardiopulmonary resuscitation |
ROSC | Return of spontaneous circulation |
SI | Sustained Inflation |
O2 | Oxygen |
PPV | Positive pressure ventilation |
3:1 | Compression to Ventilation ratio |
IQR | Interquartile range |
References
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Sham(n = 4) | CC + SI | CCaV | p-Value | |||
---|---|---|---|---|---|---|
21% Oxygen (n = 7) | 100% Oxygen (n = 7) | 21% Oxygen (n = 7) | 100% Oxygen (n = 7) | |||
Age (days) | 22 (21–22) | 22 (21–23) | 22 (21–22) | 23 (21–25) | 22 (21–24) | 0.286 |
Weight (kg) | 8.0 (7.4–8.6) | 7.9 (7.7–8.1) | 7.9 (7.0–8.6) | 7.8 (7.5–9.1) | 8.1 (6.9–9.3) | 0.889 |
Sex (male/female) | 1/3 | 4/3 | 4/3 | 6/1 | 2/5 | 0.196 |
Heart rate (bpm) | 147 (117–224) | 134 (127–145) | 144 (139–158) | 132 (128–148) | 154 (136–173) | 0.235 |
MAP (mmHg) | 73 (64–82) | 68 (62–77) | 61 (55–72) | 70 (61–88) | 63 (60–65) | 0.198 |
Carotid flow (mL/min) | 73 (62–96) | 71 (52–85) | 77 (66–129) | 74 (55–82) | 66 (46–85) | 0.574 |
Cerebral oxygenation (%) | 52 (49–53) | 51 (46–57) | 67 (45–77) | 57 (53–67) | 60 (44–75) | 0.489 |
pH | 7.39 (7.33–7.46) | 7.42 (7.35–7.46) | 7.46 (7.42–7.49) | 7.47 (7.41–7.48) | 7.44 (7.40–7.49) | 0.351 |
Base excess (mmol/L) | 2 (−3.3~4.3) | 0 (−2.0~4.0) | 2 (0~3.0) | 2 (1.0~3.1) | 2 (1.0~3.0) | 0.649 |
paCO2 (torr) | 39 (32–40) | 39 (36–42) | 37 (36–38) | 36 (35–39) | 38 (36–42) | 0.942 |
SaO2 (%) | 97 (97–99) | 98 (96–98) | 98 (94–99) | 99 (99–99) | 96 (94–99) | 0.181 |
Lactate (mmol/L) | 2.1 (1.6–4.8) | 2.1 (1.8–2.9) | 2.4 (2.2–2.9) | 2.1 (1.7–3.3) | 2.4 (1.8–2.5) | 0.878 |
CC + SI | CCaV | p-Value | ||||
---|---|---|---|---|---|---|
21% Oxygen (n = 7) | 100% Oxygen (n = 7) | 21% Oxygen (n = 7) | 100% Oxygen (n = 7) | |||
Asphyxia time (s) † | 330 (305–451) | 350 (324–429) | 315 (263–435) | 335 (240–435) | 0.91 | |
Immediately before resuscitation | pH† | 6.94 (6.93–7.07) | 7.02 (6.89–7.12) | 7.09 (6.94–7.14) | 7.04 (6.95–7.13) | 0.46 |
paCO2 (torr) † | 107 (83–114) | 88 (74–103) | 89 (80–110) | 94 (84–105) | 0.52 | |
Lactate (mmol/L) † | 9.7 (8.8–10.4) | 9.0 (7.4–11.9) | 8.2 (6.3–9.1) | 7.6 (6.5–9.5) | 0.24 | |
Base excess (mmol/L) | −8 (−10~−6) | −8 (-11~−5) | −6 (−9~−2) | −3 (−9~−2) | 0.19 | |
Resuscitation | Received epinephrine (n) | 6 (86%) | 7 (100%) | 5 (71%) | 7 (100%) | 0.25 |
Epinephrine doses (n) † | 1 (1–7) | 2 (1–3) | 9 (0–9) | 9 (1–9) | 0.33 | |
Ringer solution bolus (mL) † | 10 (10–80) | 20 (5–25) | 75 (0–90) | 70 (5–90) | 0.37 | |
Achieving ROSC | 6 (86%) | 6 (86%) | 3 (43%) | 3 (43%) | 0.13 | |
ROSC time (s) † | 107 (90–440) | 140 (105–200) | 600 (50–600) | 600 (95–600) | 0.27 | |
Survival after ROSC | 5 (83%) | 6 (100%) | 3 (100%) | 3 (100%) | 0.55 |
Sham | CC + SI | CCaV | p-Value | |||
---|---|---|---|---|---|---|
21% Oxygen | 100% Oxygen | 21% Oxygen | 100% Oxygen | |||
pH | ||||||
Baseline | 7.39 (7.33–7.46) | 7.42 (7.35–7.46) | 7.46 (7.42–7.49) | 7.47 (7.41–7.48) | 7.44 (7.40–7.49) | 0.351 |
After asphyxiation | N/A | 6.94 (6.93–7.07) # | 7.02 (6.89–7.12) # | 7.09 (6.94–7.14) # | 7.04 (6.96–7.13) # | 0.460 |
30 min after resuscitation | 7.42 (7.38–7.463) | 7.35 (7.26–7.40) | 7.29 (7.17–7.34) | 7.32 (7.19–7.36) | 7.38 (7.24–7.46) | 0.178 |
PaCO2 (torr) | ||||||
Baseline | 39 (32–40) | 39 (36–42) | 37 (36–38) | 36 (35–39) | 38 (36–42) | 0.942 |
After asphyxiation | N/A | 106 (83–114) # | 88 (74–103) # | 89 (80–110) # | 94 (84–105) # | 0.516 |
30 min after resuscitation | 36 (34–40) | 39 (29–44) | 40 (38–56) | 37 (36–52) | 37 (31–42) | 0.456 |
Base excess (mmol/L) | ||||||
Baseline | 2 (−3~4) | 0 (−2~4) | 2 (0~3) | 2 (1~ 3) | 2 (1~3) | 0.649 |
After asphyxiation | N/A | −8 (−10~−6) # | −8 (−11~−5) # | −6 (−9~ −2) # | −5 (−9~−3) # | 0.335 |
30 min after resuscitation | 1 (−4~3) | −6 (−9~−4) * # | −7 (−11~−6) * # | −7 (−8~ −5) * # | −9 (−10~−4) * # | 0.033 |
Lactate (mmol/L) | ||||||
Baseline | 2.1 (1.6–4.8) | 2.1 (1.8–2.9) | 2.4 (2.2–2.9) | 2.1 (1.7–3.3) | 2.4 (1.8–2.5) | 0.878 |
After asphyxiation | N/A | 9.7 (8.8–10.5) # | 9.0 (7.4–11.9) # | 8.2 (6.3–9.1) # | 7.6 (6.5–9.5) # | 0.235 |
30 min after resuscitation | 2.4 (1.8–4.8) | 6.9 (5.6–8.6) * # | 8.2 (6.7–10.2) * # | 7.3 (6.5–8.6) * # | 7.0 (6.8–8.7) * # | 0.007 |
Respiratory Parameter | CC + SI + 21% O2 (n = 7) | CC + SI + 100% O2 (n = 7) | CCaV + 21% O2 (n = 7) | CCaV + 100% O2 (n = 7) | p-Value |
---|---|---|---|---|---|
Positive End Expiratory Pressure (cmH2O) | 31.6 (4.3) * | 27.3 (3.1) * | 6.8 (0.6) | 7.2 (1.1) | <0.001 |
Peak Inflation Flow (mL/min) | 7.4 (1.2) | 6.8 (1.1) | 3.7 (1.2) | 4.2 (-1.5) | 0.794 |
Peak Expiratory Flow (mL/min) | −15.5 (3.4) | −13.4 (2.0) | −8.0 (3.5) | −7.3 (3.8) | 0.618 |
Tidal Volume (mL/kg) # | 25.4 (6.2) | 22.4 (6.9) | 19.8 (8.2) | 18.8 (9.9) | 0.675 |
Minute Ventilation (mL/min) # | 2678 (664) * | 2418 (591) * | 401 (172) | 530 (436) | 0.003 |
Sham | CC + SI | CCaV | p-Value | |||
---|---|---|---|---|---|---|
(n = 4) | 21% Oxygen (n = 5) | 100% Oxygen (n = 6) | 21% Oxygen (n = 3) | 100% Oxygen (n = 3) | ||
Left ventricle | ||||||
GSSG (µM/mg protein) | 171 (28) | 191 (54) | 248 (123) | 177 (49) | 177 (52) | 0.53 |
GSH (µM/mg protein) | 879 (158) | 805 (158) | 1029 (394) | 1130 (311) | 662 (60) | 0.44 |
GSSG/GSH | 0.19 (0.05) | 0.24 (0.07) | 0.26 (0.1) | 0.17 (0.03) | 0.27 (0.08) | 0.32 |
Lactate (µM/mg protein) | 0.11 (0.05) | 0.33 (0.15)* | 0.28 (0.06) | 0.23 (0.04) | 0.29 (0.06) | 0.015 |
Lung | ||||||
GSSG (µM/mg protein) | 138 (32) | 185 (59) | 198 (51) | 169 (46) | 201 (31) | 0.47 |
GSH (µM/mg protein) | 909 (121) | 883 (155) | 802 (314) | 712 (173) | 583 (197) | 0.49 |
GSSG/GSH | 0.15 (0.04) | 0.21 (0.09) | 0.28 (0.1) | 0.25 (0.09) | 0.41 (0.21) | 0.07 |
Lactate (µM/mg protein) | 0.15 (0.02) | 0.25 (0.03) | 0.27 (0.03)* | 0.25 (0.03) | 0.34 (0.3) * | 0.004 |
Brain | ||||||
GSSG (µM/mg protein) | 129 (31) | 119 (41) | 197 (48) | 117 (28) | 106 (22) | 0.07 |
GSH (µM/mg protein) | 797 (226) | 638 (205) | 606 (235) | 633 (307) | 438 (213) | 0.55 |
GSSG/GSH | 0.19 (0.05) | 0.22 (0.12) | 0.35 (0.13) | 0.25 (0.17) | 0.34 (0.21) | 0.39 |
Lactate (µM/mg protein) | 0.12 (0.02) | 0.25 (0.05) * | 0.22 (0.01) | 0.23 (0.04) | 0.29 (0.13) * | 0.010 |
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Nyame, S.; Cheung, P.-Y.; Lee, T.-F.; O’Reilly, M.; Schmölzer, G.M. A Randomized, Controlled Animal Study: 21% or 100% Oxygen during Cardiopulmonary Resuscitation in Asphyxiated Infant Piglets. Children 2022, 9, 1601. https://doi.org/10.3390/children9111601
Nyame S, Cheung P-Y, Lee T-F, O’Reilly M, Schmölzer GM. A Randomized, Controlled Animal Study: 21% or 100% Oxygen during Cardiopulmonary Resuscitation in Asphyxiated Infant Piglets. Children. 2022; 9(11):1601. https://doi.org/10.3390/children9111601
Chicago/Turabian StyleNyame, Solomon, Po-Yin Cheung, Tez-Fun Lee, Megan O’Reilly, and Georg M. Schmölzer. 2022. "A Randomized, Controlled Animal Study: 21% or 100% Oxygen during Cardiopulmonary Resuscitation in Asphyxiated Infant Piglets" Children 9, no. 11: 1601. https://doi.org/10.3390/children9111601