Table_3_Successful Resuscitation in a Model of Asphyxia and Hemorrhage to Test Different Volume Resuscitation Strategies. A Study in Newborn Piglets After Transition.pdf

Background: Evidence for recommendations on the use of volume expansion during cardiopulmonary resuscitation in newborn infants is limited.Objectives: To develop a newborn piglet model with asphyxia, hemorrhage, and cardiac arrest to test different volume resuscitation on return of spontaneous circulation (ROSC). We hypothesized that immediate red cell transfusion reduces time to ROSC as compared to the use of an isotonic crystalloid fluid.Methods: Forty-four anaesthetized and intubated newborn piglets [age 32 h (12–44 h), weight 1,220 g (1,060–1,495g), Median (IQR)] were exposed to hypoxia and blood loss until asystole occurred. At this point they were randomized into two groups: (1) Crystalloid group: receiving isotonic sodium chloride (n = 22). (2) Early transfusion group: receiving blood transfusion (n = 22). In all other ways the piglets were resuscitated according to ILCOR 2015 guidelines [including respiratory support, chest compressions (CC) and epinephrine use]. One hour after ROSC piglets from the crystalloid group were randomized in two sub-groups: late blood transfusion and infusion of isotonic sodium chloride to investigate the effects of a late transfusion on hemodynamic parameters.Results: All animals achieved ROSC. Comparing the crystalloid to early blood transfusion group blood loss was 30.7 ml/kg (22.3–39.6 ml/kg) vs. 34.6 ml/kg (25.2–44.7 ml/kg), Median (IQR). Eleven subjects did not receive volume expansion as ROSC occurred rapidly. Thirty-three animals received volume expansion (16 vs. 17 in the crystalloid vs. early transfusion group). 14.1% vs. 10.5% of previously extracted blood volume in the crystalloid vs. early transfusion group was infused before ROSC. There was no significant difference in time to ROSC between groups [crystalloid group: 164 s (129–198 s), early transfusion group: 163 s (162–199 s), Median (IQR)] with no difference in epinephrine use.Conclusions: Early blood transfusion compared to crystalloid did not reduce time to ROSC, although our model included only a moderate degree of hemorrhage and ROSC occurred early in 11 subjects before any volume resuscitation occurred.

背景：关于新生儿心肺复苏期间使用容量扩充的建议依据有限。目标：旨在构建一种新生儿猪仔窒息、出血和心跳骤停模型，以测试不同体积复苏对自发循环恢复（ROSC）的影响。我们假设，与使用等渗晶体液相比，立即红细胞输注可以缩短ROSC时间。方法：对44只麻醉和插管的足月新生儿猪仔（年龄32小时（12-44小时），体重1,220克（1,060-1,495克），中位数（四分位数间距））进行缺氧和失血处理，直至发生心室停搏。在此阶段，它们被随机分为两组：（1）晶体液组：接受等渗氯化钠（n = 22）。（2）早期输血组：接受血液输注（n = 22）。在其他所有方面，猪仔的复苏均按照ILCOR 2015指南进行[包括呼吸支持、胸部按压（CC）和肾上腺素的使用]。ROSC后一小时，晶体液组的猪仔被随机分为两个亚组：晚期输血和等渗氯化钠的输注，以研究晚期输血对血流动力学参数的影响。结果：所有动物均实现了ROSC。与早期输血组相比，晶体液组的出血量为30.7毫升/千克（22.3-39.6毫升/千克）与34.6毫升/千克（25.2-44.7毫升/千克），中位数（四分位数间距）。11个对象未接受容量扩充，因为ROSC发生迅速。33只动物接受了容量扩充（晶体液组16只，早期输血组17只）。晶体液组与早期输血组中，在ROSC前输注的先前提取的血量分别为14.1%与10.5%。两组在ROSC时间上无显著差异[晶体液组：164秒（129-198秒），早期输血组：163秒（162-199秒），中位数（四分位数间距）]，肾上腺素使用量也无差异。结论：与晶体液相比，早期输血并未缩短ROSC时间，尽管我们的模型仅包含中度的出血程度，且11个对象在任何容量复苏发生之前ROSC均已发生较早。