• Pediatr Crit Care Me · Jul 2019

    The Effect of Asphyxia Arrest Duration on a Pediatric End-Tidal CO2-Guided Chest Compression Delivery Model.

    • Jennifer L Hamrick, Justin T Hamrick, Caitlin E O'Brien, Michael Reyes, Polan T Santos, Sophie E Heitmiller, Ewa Kulikowicz, Jennifer K Lee, Sapna R Kudchadkar, Raymond C Koehler, Elizabeth A Hunt, and Donald H Shaffner.
    • Department of Anesthesiology, Rady Children's Hospital, San Diego, CA.
    • Pediatr Crit Care Me. 2019 Jul 1; 20 (7): e352-e361.

    ObjectivesTo determine the effect of the duration of asphyxial arrest on the survival benefit previously seen with end-tidal CO2-guided chest compression delivery.DesignPreclinical randomized controlled study.SettingUniversity animal research laboratory.SubjectsTwo-week-old swine.InterventionsAfter either 17 or 23 minutes of asphyxial arrest, animals were randomized to standard cardiopulmonary resuscitation or end-tidal CO2-guided chest compression delivery. Standard cardiopulmonary resuscitation was optimized by marker, monitor, and verbal feedback about compression rate, depth, and release. End-tidal CO2-guided delivery used adjustments to chest compression rate and depth to maximize end-tidal CO2 level without other feedback. Cardiopulmonary resuscitation for both groups proceeded from 10 minutes of basic life support to 10 minutes of advanced life support or return of spontaneous circulation.Measurements And Main ResultsAfter 17 minutes of asphyxial arrest, mean end-tidal CO2 during 10 minutes of cardiopulmonary resuscitation was 18 ± 9 torr in the standard group and 33 ± 15 torr in the end-tidal CO2 group (p = 0.004). The rate of return of spontaneous circulation was three of 14 (21%) in the standard group rate and nine of 14 (64%) in the end-tidal CO2 group (p = 0.05). After a 23-minute asphyxial arrest, neither end-tidal CO2 values (20 vs 26) nor return of spontaneous circulation rate (3/14 vs 1/14) differed between the standard and end-tidal CO2-guided groups.ConclusionsOur previously observed survival benefit of end-tidal CO2-guided chest compression delivery after 20 minutes of asphyxial arrest was confirmed after 17 minutes of asphyxial arrest. The poor survival after 23 minutes of asphyxia shows that the benefit of end-tidal CO2-guided chest compression delivery is limited by severe asphyxia duration.

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