Exhaled CO2 Parameters as a Tool to Assess Ventilation-Perfusion Mismatching during Neonatal Resuscitation in a Swine Model of Neonatal Asphyxia

PLOS ONE, Dec 2019

Background End-tidal CO2 (ETCO2), partial pressure of exhaled CO2 (PECO2), and volume of expired CO2 (VCO2) can be continuously monitored non-invasively to reflect pulmonary ventilation and perfusion status. Although ETCO2 ≥14mmHg has been shown to be associated with return of an adequate heart rate in neonatal resuscitation and quantifying the PECO2 has the potential to serve as an indicator of resuscitation quality, there is little information regarding capnometric measurement of PECO2 and ETCO2 in detecting return of spontaneous circulation (ROSC) and survivability in asphyxiated neonates receiving cardiopulmonary resuscitation (CPR). Methods Seventeen newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by apnea to induce asphyxia. Protocolized resuscitation was initiated when heart rate decreased to 25% of baseline. Respiratory and hemodynamic parameters including ETCO2, PECO2, VCO2, heart rate, cardiac output, and carotid artery flow were continuously measured and analyzed. Results There were no differences in respiratory and hemodynamic parameters between surviving and non-surviving piglets prior to CPR. Surviving piglets had significantly higher ETCO2, PECO2, VCO2, cardiac index, and carotid artery flow values during CPR compared to non-surviving piglets. Conclusion Surviving piglets had significantly better respiratory and hemodynamic parameters during resuscitation compared to non-surviving piglets. In addition to optimizing resuscitation efforts, capnometry can assist by predicting outcomes of newborns requiring chest compressions.

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Exhaled CO2 Parameters as a Tool to Assess Ventilation-Perfusion Mismatching during Neonatal Resuscitation in a Swine Model of Neonatal Asphyxia

January Exhaled CO2 Parameters as a Tool to Assess Ventilation-Perfusion Mismatching during Neonatal Resuscitation in a Swine Model of Neonatal Asphyxia Elliott Shang-shun Li 0 1 2 3 Po-Yin Cheung 0 1 2 3 Megan O'Reilly 0 1 2 3 Joseph LaBossiere 0 2 3 Tze- Fun Lee 0 1 2 3 Shaun Cowan 0 2 3 David L. Bigam 0 2 3 Georg Marcus Schmölzer 0 1 2 3 0 dynamic parameters including ETCO 1 , heart rate, cardiac output 2 1 Faculty of Science, McGill University , Montreal, Quebec , Canada , 2 Department of Pediatrics, University of Alberta , Edmonton, Alberta , Canada , 3 Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital , Edmonton, Alberta , Canada , 4 Department of Surgery, University of Alberta , Edmonton, Alberta , Canada , 5 Faculty of Science, University of Alberta , Edmonton, Alberta , Canada 3 Editor: Edgardo Szyld, Icahn School of Medicine at Mount Sinai , ARGENTINA End-tidal CO2 (ETCO2), partial pressure of exhaled CO2 (PECO2), and volume of expired CO2 (VCO2) can be continuously monitored non-invasively to reflect pulmonary ventilation Methods Seventeen newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by apnea to induce asphyxia. Protocolized resuscitation was initiated when heart rate decreased to 25% of baseline. Respiratory and hemocarotid artery flow were continuously measured and analyzed. - Data Availability Statement: All relevant data are within the paper and its Supporting Information file. Funding: The authors would like to thank the Laerdal Foundation for Acute Medicine, Norway, (http://www. laerdalfoundation.org) for their support of the current study. ESL was supported in part by the Northern Alberta Clinical Trials and Research Centre, Faculty of Medicine and Dentistry, University of Alberta, and Neonatal Research Fund, Northern Alberta Neonatal Program, Alberta Health Services. MOR is supported by a Fellowship of Molly Towell Perinatal Research Background and perfusion status. Although ETCO2 14mmHg has been shown to be associated with return of an adequate heart rate in neonatal resuscitation and quantifying the PECO2 has the potential to serve as an indicator of resuscitation quality, there is little information regarding capnometric measurement of PECO2 and ETCO2 in detecting return of spontaneous circulation (ROSC) and survivability in asphyxiated neonates receiving cardiopulmonary resuscitation (CPR). Results surviving piglets. There were no differences in respiratory and hemodynamic parameters between surviving and non-surviving piglets prior to CPR. Surviving piglets had significantly higher ETCO2, PECO2, VCO2, cardiac index, and carotid artery flow values during CPR compared to non Foundation, Edmonton, Alberta, Canada. GMS is a recipient of the Heart and Stroke Foundation/ University of Alberta Professorship of Neonatal Resuscitation and a Heart and Stroke Foundation Canada Research Scholarship. No relation with industry exists. Respironics (Philips, Wallingford, CT) and Fisher & Paykel (Auckland, New Zealand) provided a respiratory function monitor and Neopuff T-pieces for the study, respectively. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have read the journal's policy and the authors of this manuscript have the following competing interests: Respironics (Philips, Wallingford, CT) and Fisher & Paykel (Auckland, New Zealand) provided a respiratory function monitor and Neopuff T-pieces for the study, respectively. Neither company was involved in the design of the study, data acquisition, data analysis and interpretation of results, and both companies were not involved in writing of the manuscript. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials. Conclusion Surviving piglets had significantly better respiratory and hemodynamic parameters during resuscitation compared to non-surviving piglets. In addition to optimizing resuscitation efforts, capnometry can assist by predicting outcomes of newborns requiring chest compressions. Introduction Neonatal asphyxia is a common cause of mortality and morbidity and worldwide contributes to approximately 1 million deaths annually. It has been reported that 0.08% of term-born neonates required cardiopulmonary resuscitation (CPR) [ 1 ]. In the latest guidelines on neonatal resuscitation, the American Heart Association states that if the heart rate remains undetected after 10 minutes in asystolic neonates, discontinuing the resuscitation efforts is justified [ 2 ]. However, the decision to discontinue resuscitation may be influenced by issues such as the presumed aetiology of the arrest, gestation of the baby, potential reversibility of the situation, and parents’ previou (...truncated)


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Elliott Shang-shun Li, Po-Yin Cheung, Megan O'Reilly, Joseph LaBossiere, Tze-Fun Lee, Shaun Cowan, David L. Bigam, Georg Marcus Schmölzer. Exhaled CO2 Parameters as a Tool to Assess Ventilation-Perfusion Mismatching during Neonatal Resuscitation in a Swine Model of Neonatal Asphyxia, PLOS ONE, 2016, 1, DOI: 10.1371/journal.pone.0146524