Randomized trial of volume infusion during resuscitation of asphyxiated neonatal piglets

Myra Wyckoff, Damian Garcia, Linda Margraf, Jeffrey Perlman, Abbot Laptook

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Despite its use, there is little evidence to support volume infusion (VI) during neonatal cardiopulmonary resuscitation (CPR). This study compares 5% albumin (ALB), normal saline (NS), and no VI (SHAM) on development of pulmonary edema and restoration of mean arterial pressure (MAP) during resuscitation of asphyxiated piglets. Mechanically ventilated swine (n = 37, age: 8 ± 4 d, weight: 2.2 ± 0.7 kg) were progressively asphyxiated until pH <7.0, Paco2 >100 mm Hg, heart rate (HR) <100 bpm, and MAP <20 mm Hg. After 5 min of ventilatory resuscitation, piglets were randomized blindly to ALB, NS, or SHAM infusion. Animals were recovered for 2 h before euthanasia and lung tissue sampled for wet-to-dry weight ratio (W/D) as a marker of pulmonary edema. SHAM MAP was similar to VI during resuscitation. At 2 h post-resuscitation, MAP of SHAM (48 ± 13 mm Hg) and ALB (43 ± 19 mm Hg) was higher than NS (29 ± 10 mm Hg; p = 0.003 and 0.023, respectively). After resuscitation, SHAM piglets had less pulmonary edema (W/D: 5.84 ± 0.12 versus 5.98 ± 0.19; p = 0.03) and better dynamic compliance (Cd) compared with ALB or NS (Cd: 1.43 ± 0.69 versus 0.97 ± 0.37 mL/cm H2O, p = 0.018). VI during resuscitation did not improve MAP, and acute recovery of MAP was poorer with NS compared with ALB. VI was associated with increased pulmonary edema. In the absence of hypovolemia, VI during neonatal resuscitation is not beneficial.

Original languageEnglish (US)
Pages (from-to)415-420
Number of pages6
JournalPediatric Research
Volume61
Issue number4
DOIs
StatePublished - Apr 1 2007

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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