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Selected Publication:
Krainer, M.
Improving cardiopulmonary resuscitation in newborn infants
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medizinische Universität Graz; 2023. pp. 104
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- Authors Med Uni Graz:
- Advisor:
- Heschl Stefan
- Pichler Gerhard
- Schmölzer Georg
- Urlesberger Berndt
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- Abstract:
- Background: Current neonatal resuscitation guidelines recommend providing chest compressions (CC) with the encircling two-thumb-technique (TTT). These recommendations are based on manikin studies and expert opinion rather than on animal or clinical data. Until now there are no studies investigating different CC techniques in animal experiments published. The aim of the study was to compare hemodynamic and respiratory parameters when providing CC with the TTT, the conventional two-finger-technique (TFT), the knocking-fingers technique (KFT), and the over-the-head two-thumb encircling technique (OTTT) in an asphyxiated neonatal piglet model. We hypothesised that in newborn asphyxiated piglets the TTT compared to the other CC techniques improve carotid blood flow during cardiopulmonary resuscitation (CPR). Methods: We included newborn mixed-breed piglets, between zero and three days of age obtained from the University Swine Research Technology Center, University of Alberta, Canada. Newborn piglets were anesthetized, intubated, instrumented, and exposed to normocapnic hypoxia followed by asphyxia. This led to bradycardia and finally asystole. Each of the four CC techniques (TTT, TFT, KFT, and OTTT) was sequently performed in each piglet in random order. After one minute the CPR with one technique was changed to another one, again for one minute. Hemodynamic and respiratory parameters were continuously measured. Results: A total of seven piglets were included with a median (range) age of 3 (1-4) days old and weight 2.0 (1.8-2.1) kg. There were no differences in the carotid blood flow (ml/min/kg), the percentage changes of mean carotid blood flow to baseline, in blood pressure, end diastolic volume, or maximal rate of rise of left ventricular pressure between the groups. The rise of carotid blood flow per CC was significantly faster with the TTT and OTTT (118 (45) and 121 (46) mL/min/s) compared to the TFT and the KFT (75 (48) and 71 (67) mL/min/s) (p<0.001). Using the TFT and the KFT resulted in significantly lower minimum rate of change of ventricular pressure (as an expression of left ventricular function) compared to the TTT (TFT -568 (229) and KFT -578 (180) vs. TTT -1052 (369); p=0.012). There were no differences in respiratory parameter, cerebral tissue oxygen saturation, and CC force and depth between the different CC techniques during CPR. Conclusion: Using the encircling two-thumb-technique and the over-the-head two-thumb encircling technique resulted in faster rise of carotid blood flow and higher minimum rate of change of ventricular pressure suggesting a slightly better left ventricular ejection. However, those differences did not result in improved carotid blood flow. This study demonstrated that investigating different CC techniques in neonatal animal models is feasible. Further animal studies are warranted to investigate the outcome of different CC techniques.