Randomized trial of oxygen weaning strategies following chest compressions during neonatal resuscitation

Deepika Sankaran; Payam Vali; Peggy Chen; Amy L. Lesneski; Morgan E. Hardie; Ziad Alhassen; Stephen Wedgwood; Myra H. Wyckoff; Satyan Lakshminrusimha

doi:10.1038/s41390-021-01551-1

Randomized trial of oxygen weaning strategies following chest compressions during neonatal resuscitation

Deepika Sankaran, Payam Vali, Peggy Chen, Amy L. Lesneski, Morgan E. Hardie, Ziad Alhassen, Stephen Wedgwood, Myra H. Wyckoff, Satyan Lakshminrusimha

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

Background: The Neonatal Resuscitation Program (NRP) recommends using 100% O₂ during chest compressions and adjusting FiO₂ based on SpO₂ after return of spontaneous circulation (ROSC). The optimal strategy for adjusting FiO₂ is not known. Methods: Twenty-five near-term lambs asphyxiated by umbilical cord occlusion to cardiac arrest were resuscitated per NRP. Following ROSC, lambs were randomized to gradual decrease versus abrupt wean to 21% O₂ followed by FiO₂ titration to achieve NRP SpO₂ targets. Carotid blood flow and blood gases were monitored. Results: Three minutes after ROSC, PaO₂ was 229 ± 32 mmHg in gradual wean group compared to 57 ± 13 following abrupt wean to 21% O₂ (p < 0.001). PaO₂ remained high in the gradual wean group at 10 min after ROSC (110 ± 10 vs. 67 ± 12, p < 0.01) despite similar FiO₂ (~0.3) in both groups. Cerebral O₂ delivery (C-DO₂) was higher above physiological range following ROSC with gradual wean (p < 0.05). Lower blood oxidized/reduced glutathione ratio (suggesting less oxidative stress) was observed with abrupt wean. Conclusion: Weaning FiO₂ abruptly to 0.21 with adjustment based on SpO₂ prevents surge in PaO₂ and C-DO₂ and minimizes oxidative stress compared to gradual weaning from 100% O₂ following ROSC. Clinical trials with neurodevelopmental outcomes comparing post-ROSC FiO₂ weaning strategies are warranted. Impact: In a lamb model of perinatal asphyxial cardiac arrest, abrupt weaning of inspired oxygen to 21% prevents excessive oxygen delivery to the brain and oxidative stress compared to gradual weaning from 100% oxygen following return of spontaneous circulation.Clinical studies assessing neurodevelopmental outcomes comparing abrupt and gradual weaning of inspired oxygen after recovery from neonatal asphyxial arrest are warranted.

Original language	English (US)
Pages (from-to)	540-548
Number of pages	9
Journal	Pediatric Research
Volume	90
Issue number	3
DOIs	https://doi.org/10.1038/s41390-021-01551-1
State	Published - Sep 2021

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

Access to Document

10.1038/s41390-021-01551-1

Cite this

@article{34476995797c4b408b66ebda2d7f2f48,

title = "Randomized trial of oxygen weaning strategies following chest compressions during neonatal resuscitation",

abstract = "Background: The Neonatal Resuscitation Program (NRP) recommends using 100% O2 during chest compressions and adjusting FiO2 based on SpO2 after return of spontaneous circulation (ROSC). The optimal strategy for adjusting FiO2 is not known. Methods: Twenty-five near-term lambs asphyxiated by umbilical cord occlusion to cardiac arrest were resuscitated per NRP. Following ROSC, lambs were randomized to gradual decrease versus abrupt wean to 21% O2 followed by FiO2 titration to achieve NRP SpO2 targets. Carotid blood flow and blood gases were monitored. Results: Three minutes after ROSC, PaO2 was 229 ± 32 mmHg in gradual wean group compared to 57 ± 13 following abrupt wean to 21% O2 (p < 0.001). PaO2 remained high in the gradual wean group at 10 min after ROSC (110 ± 10 vs. 67 ± 12, p < 0.01) despite similar FiO2 (~0.3) in both groups. Cerebral O2 delivery (C-DO2) was higher above physiological range following ROSC with gradual wean (p < 0.05). Lower blood oxidized/reduced glutathione ratio (suggesting less oxidative stress) was observed with abrupt wean. Conclusion: Weaning FiO2 abruptly to 0.21 with adjustment based on SpO2 prevents surge in PaO2 and C-DO2 and minimizes oxidative stress compared to gradual weaning from 100% O2 following ROSC. Clinical trials with neurodevelopmental outcomes comparing post-ROSC FiO2 weaning strategies are warranted. Impact: In a lamb model of perinatal asphyxial cardiac arrest, abrupt weaning of inspired oxygen to 21% prevents excessive oxygen delivery to the brain and oxidative stress compared to gradual weaning from 100% oxygen following return of spontaneous circulation.Clinical studies assessing neurodevelopmental outcomes comparing abrupt and gradual weaning of inspired oxygen after recovery from neonatal asphyxial arrest are warranted.",

author = "Deepika Sankaran and Payam Vali and Peggy Chen and Lesneski, {Amy L.} and Hardie, {Morgan E.} and Ziad Alhassen and Stephen Wedgwood and Wyckoff, {Myra H.} and Satyan Lakshminrusimha",

note = "Publisher Copyright: {\textcopyright} 2021, The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.",

year = "2021",

month = sep,

doi = "10.1038/s41390-021-01551-1",

language = "English (US)",

volume = "90",

pages = "540--548",

journal = "Pediatric Research",

issn = "0031-3998",

publisher = "Lippincott Williams and Wilkins",

number = "3",

}

TY - JOUR

T1 - Randomized trial of oxygen weaning strategies following chest compressions during neonatal resuscitation

AU - Sankaran, Deepika

AU - Vali, Payam

AU - Chen, Peggy

AU - Lesneski, Amy L.

AU - Hardie, Morgan E.

AU - Alhassen, Ziad

AU - Wedgwood, Stephen

AU - Wyckoff, Myra H.

AU - Lakshminrusimha, Satyan

PY - 2021/9

Y1 - 2021/9

N2 - Background: The Neonatal Resuscitation Program (NRP) recommends using 100% O2 during chest compressions and adjusting FiO2 based on SpO2 after return of spontaneous circulation (ROSC). The optimal strategy for adjusting FiO2 is not known. Methods: Twenty-five near-term lambs asphyxiated by umbilical cord occlusion to cardiac arrest were resuscitated per NRP. Following ROSC, lambs were randomized to gradual decrease versus abrupt wean to 21% O2 followed by FiO2 titration to achieve NRP SpO2 targets. Carotid blood flow and blood gases were monitored. Results: Three minutes after ROSC, PaO2 was 229 ± 32 mmHg in gradual wean group compared to 57 ± 13 following abrupt wean to 21% O2 (p < 0.001). PaO2 remained high in the gradual wean group at 10 min after ROSC (110 ± 10 vs. 67 ± 12, p < 0.01) despite similar FiO2 (~0.3) in both groups. Cerebral O2 delivery (C-DO2) was higher above physiological range following ROSC with gradual wean (p < 0.05). Lower blood oxidized/reduced glutathione ratio (suggesting less oxidative stress) was observed with abrupt wean. Conclusion: Weaning FiO2 abruptly to 0.21 with adjustment based on SpO2 prevents surge in PaO2 and C-DO2 and minimizes oxidative stress compared to gradual weaning from 100% O2 following ROSC. Clinical trials with neurodevelopmental outcomes comparing post-ROSC FiO2 weaning strategies are warranted. Impact: In a lamb model of perinatal asphyxial cardiac arrest, abrupt weaning of inspired oxygen to 21% prevents excessive oxygen delivery to the brain and oxidative stress compared to gradual weaning from 100% oxygen following return of spontaneous circulation.Clinical studies assessing neurodevelopmental outcomes comparing abrupt and gradual weaning of inspired oxygen after recovery from neonatal asphyxial arrest are warranted.

AB - Background: The Neonatal Resuscitation Program (NRP) recommends using 100% O2 during chest compressions and adjusting FiO2 based on SpO2 after return of spontaneous circulation (ROSC). The optimal strategy for adjusting FiO2 is not known. Methods: Twenty-five near-term lambs asphyxiated by umbilical cord occlusion to cardiac arrest were resuscitated per NRP. Following ROSC, lambs were randomized to gradual decrease versus abrupt wean to 21% O2 followed by FiO2 titration to achieve NRP SpO2 targets. Carotid blood flow and blood gases were monitored. Results: Three minutes after ROSC, PaO2 was 229 ± 32 mmHg in gradual wean group compared to 57 ± 13 following abrupt wean to 21% O2 (p < 0.001). PaO2 remained high in the gradual wean group at 10 min after ROSC (110 ± 10 vs. 67 ± 12, p < 0.01) despite similar FiO2 (~0.3) in both groups. Cerebral O2 delivery (C-DO2) was higher above physiological range following ROSC with gradual wean (p < 0.05). Lower blood oxidized/reduced glutathione ratio (suggesting less oxidative stress) was observed with abrupt wean. Conclusion: Weaning FiO2 abruptly to 0.21 with adjustment based on SpO2 prevents surge in PaO2 and C-DO2 and minimizes oxidative stress compared to gradual weaning from 100% O2 following ROSC. Clinical trials with neurodevelopmental outcomes comparing post-ROSC FiO2 weaning strategies are warranted. Impact: In a lamb model of perinatal asphyxial cardiac arrest, abrupt weaning of inspired oxygen to 21% prevents excessive oxygen delivery to the brain and oxidative stress compared to gradual weaning from 100% oxygen following return of spontaneous circulation.Clinical studies assessing neurodevelopmental outcomes comparing abrupt and gradual weaning of inspired oxygen after recovery from neonatal asphyxial arrest are warranted.

UR - http://www.scopus.com/inward/record.url?scp=85105330877&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85105330877&partnerID=8YFLogxK

U2 - 10.1038/s41390-021-01551-1

DO - 10.1038/s41390-021-01551-1

M3 - Article

C2 - 33941864

AN - SCOPUS:85105330877

SN - 0031-3998

VL - 90

SP - 540

EP - 548

JO - Pediatric Research

JF - Pediatric Research

IS - 3

ER -

Randomized trial of oxygen weaning strategies following chest compressions during neonatal resuscitation

Abstract

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this