Hemodynamics and gas exchange during chest compressions in neonatal resuscitation

Payam Vali, Praveen Chandrasekharan, Munmun Rawat, Sylvia Gugino, Carmon Koenigsknecht, Justin Helman, Bobby Mathew, Sara Berkelhamer, Jayasree Nair, Myra Wyckoff, Satyan Lakshminrusimha

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose Current knowledge about pulmonary/systemic hemodynamics and gas exchange during neonatal resuscitation in a model of transitioning fetal circulation with fetal shunts and fluidfilled alveoli is limited. Using a fetal lamb asphyxia model, we sought to determine whether hemodynamic or gas-exchange parameters predicted successful return of spontaneous circulation (ROSC). Methods The umbilical cord was occluded in 22 lambs to induce asphyxial cardiac arrest. Following five minutes of asystole, resuscitation as per AHA-Neonatal Resuscitation Program guidelines was initiated. Hemodynamic parameters and serial arterial blood gases were assessed during resuscitation. Results ROSC occurred in 18 lambs (82%) at a median (IQR) time of 120 (105-180) seconds. There were no differences in hemodynamic parameters at baseline and at any given time point during resuscitation between the lambs that achieved ROSC and those that did not. Blood gases at arrest prior to resuscitation were comparable between groups. However, lambs that achieved ROSC had lower PaO2, higher PaCO2, and lower lactate during resuscitation. Increase in diastolic blood pressures induced by epinephrine in lambs that achieved ROSC (11 4 mmHg) did not differ from those that were not resuscitated (10+6 mmHg). Low diastolic blood pressures were adequate to achieve ROSC. Conclusions Hemodynamic parameters in a neonatal lamb asphyxia model with transitioning circulation did not predict success of ROSC. Lactic acidosis, higher PaO2 and lower PaCO2 observed in the lambs that did not achieve ROSC may represent a state of inadequate tissue perfusion and/or mitochondrial dysfunction.

Original languageEnglish (US)
Article numbere0176478
JournalPLoS One
Volume12
Issue number4
DOIs
StatePublished - Apr 1 2017

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Resuscitation
Hemodynamics
chest
hemodynamics
gas exchange
lambs
Thorax
Gases
asphyxia
Asphyxia
Blood pressure
cardiac arrest
Blood Pressure
Heart Arrest
diastolic blood pressure
blood gases
Blood
Lactic Acidosis
Umbilical Cord
umbilical cord

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Vali, P., Chandrasekharan, P., Rawat, M., Gugino, S., Koenigsknecht, C., Helman, J., ... Lakshminrusimha, S. (2017). Hemodynamics and gas exchange during chest compressions in neonatal resuscitation. PLoS One, 12(4), [e0176478]. https://doi.org/10.1371/journal.pone.0176478

Hemodynamics and gas exchange during chest compressions in neonatal resuscitation. / Vali, Payam; Chandrasekharan, Praveen; Rawat, Munmun; Gugino, Sylvia; Koenigsknecht, Carmon; Helman, Justin; Mathew, Bobby; Berkelhamer, Sara; Nair, Jayasree; Wyckoff, Myra; Lakshminrusimha, Satyan.

In: PLoS One, Vol. 12, No. 4, e0176478, 01.04.2017.

Research output: Contribution to journalArticle

Vali, P, Chandrasekharan, P, Rawat, M, Gugino, S, Koenigsknecht, C, Helman, J, Mathew, B, Berkelhamer, S, Nair, J, Wyckoff, M & Lakshminrusimha, S 2017, 'Hemodynamics and gas exchange during chest compressions in neonatal resuscitation', PLoS One, vol. 12, no. 4, e0176478. https://doi.org/10.1371/journal.pone.0176478
Vali P, Chandrasekharan P, Rawat M, Gugino S, Koenigsknecht C, Helman J et al. Hemodynamics and gas exchange during chest compressions in neonatal resuscitation. PLoS One. 2017 Apr 1;12(4). e0176478. https://doi.org/10.1371/journal.pone.0176478
Vali, Payam ; Chandrasekharan, Praveen ; Rawat, Munmun ; Gugino, Sylvia ; Koenigsknecht, Carmon ; Helman, Justin ; Mathew, Bobby ; Berkelhamer, Sara ; Nair, Jayasree ; Wyckoff, Myra ; Lakshminrusimha, Satyan. / Hemodynamics and gas exchange during chest compressions in neonatal resuscitation. In: PLoS One. 2017 ; Vol. 12, No. 4.
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abstract = "Purpose Current knowledge about pulmonary/systemic hemodynamics and gas exchange during neonatal resuscitation in a model of transitioning fetal circulation with fetal shunts and fluidfilled alveoli is limited. Using a fetal lamb asphyxia model, we sought to determine whether hemodynamic or gas-exchange parameters predicted successful return of spontaneous circulation (ROSC). Methods The umbilical cord was occluded in 22 lambs to induce asphyxial cardiac arrest. Following five minutes of asystole, resuscitation as per AHA-Neonatal Resuscitation Program guidelines was initiated. Hemodynamic parameters and serial arterial blood gases were assessed during resuscitation. Results ROSC occurred in 18 lambs (82{\%}) at a median (IQR) time of 120 (105-180) seconds. There were no differences in hemodynamic parameters at baseline and at any given time point during resuscitation between the lambs that achieved ROSC and those that did not. Blood gases at arrest prior to resuscitation were comparable between groups. However, lambs that achieved ROSC had lower PaO2, higher PaCO2, and lower lactate during resuscitation. Increase in diastolic blood pressures induced by epinephrine in lambs that achieved ROSC (11 4 mmHg) did not differ from those that were not resuscitated (10+6 mmHg). Low diastolic blood pressures were adequate to achieve ROSC. Conclusions Hemodynamic parameters in a neonatal lamb asphyxia model with transitioning circulation did not predict success of ROSC. Lactic acidosis, higher PaO2 and lower PaCO2 observed in the lambs that did not achieve ROSC may represent a state of inadequate tissue perfusion and/or mitochondrial dysfunction.",
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AU - Rawat, Munmun

AU - Gugino, Sylvia

AU - Koenigsknecht, Carmon

AU - Helman, Justin

AU - Mathew, Bobby

AU - Berkelhamer, Sara

AU - Nair, Jayasree

AU - Wyckoff, Myra

AU - Lakshminrusimha, Satyan

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N2 - Purpose Current knowledge about pulmonary/systemic hemodynamics and gas exchange during neonatal resuscitation in a model of transitioning fetal circulation with fetal shunts and fluidfilled alveoli is limited. Using a fetal lamb asphyxia model, we sought to determine whether hemodynamic or gas-exchange parameters predicted successful return of spontaneous circulation (ROSC). Methods The umbilical cord was occluded in 22 lambs to induce asphyxial cardiac arrest. Following five minutes of asystole, resuscitation as per AHA-Neonatal Resuscitation Program guidelines was initiated. Hemodynamic parameters and serial arterial blood gases were assessed during resuscitation. Results ROSC occurred in 18 lambs (82%) at a median (IQR) time of 120 (105-180) seconds. There were no differences in hemodynamic parameters at baseline and at any given time point during resuscitation between the lambs that achieved ROSC and those that did not. Blood gases at arrest prior to resuscitation were comparable between groups. However, lambs that achieved ROSC had lower PaO2, higher PaCO2, and lower lactate during resuscitation. Increase in diastolic blood pressures induced by epinephrine in lambs that achieved ROSC (11 4 mmHg) did not differ from those that were not resuscitated (10+6 mmHg). Low diastolic blood pressures were adequate to achieve ROSC. Conclusions Hemodynamic parameters in a neonatal lamb asphyxia model with transitioning circulation did not predict success of ROSC. Lactic acidosis, higher PaO2 and lower PaCO2 observed in the lambs that did not achieve ROSC may represent a state of inadequate tissue perfusion and/or mitochondrial dysfunction.

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