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Hemodynamic, respiratory, and perfusion parameters during asphyxia, resuscitation, and post-resuscitation in a pediatric model of cardiac arrest

Jesús López-Herce| Bárbara Fernández| Javier Urbano| Santiago Mencía| Maria José Solana| Antonio Rodríguez-Núñez| Jose María Bellón| Angel Carrillo
Experimental
Volume 37, Issue 1 / January , 2011

Pages 147 - 155

Abstract

Purpose

To analyze the evolution of hemodynamic, respiratory, and tissue perfusion parameters in an infant animal model of asphyxial cardiac arrest (CA).

Methods

This was a secondary analysis of a prospective observational study conducted at a laboratory research department of a university hospital. Seventy-one, 2-month-old piglets were studied. CA was induced by removal of mechanical ventilation. Cardiopulmonary resuscitation (CPR) was performed by means of manual external chest compressions, mechanical ventilation, epinephrine and/or terlipressin intravenous administration.

Results

The evolution of hemodynamic (heart rate, blood pressure, cardiac index), respiratory (end-tidal CO2, blood gas analysis), and tissue perfusion (intramucosal gastric pH, central, cerebral, and renal hemoglobin saturation) parameters was analyzed during three periods: asphyxia, CPR, and after return of spontaneous circulation (ROSC). During asphyxia, a severe arterial and tissue hypoxia with hypercapnia and lactic acidosis quickly developed. Bradycardia, hypotension, and increasing of systemic vascular resistances and pulmonary arterial pressure were also observed. During CPR, arterial, cerebral, and tissue oxygenation were low in spite of ventilation with oxygen 100%. After ROSC a rapid restoration of hemodynamic and respiratory parameters was observed. However, 30 min after ROSC, lactic acidosis and low intramucosal gastric pH persisted.

Conclusions

Asphyxia leads to sudden hypoxia and hypercapnia with tissue hypoxia and progressive bradycardia. Standard CPR is not able to maintain an adequate tissue oxygenation during CPR in this animal model. When ROSC is achieved, a rapid restoration of the normal values of general hemodynamic and respiratory parameters is observed, although lactic acidosis and splanchnic hypoperfusion persist in time.

Keywords

References

  1. American Heart Association with the International Liaison Committee on Resuscitation: guidelines 2005 for cardiopulmonary resuscitation and emergency care (2005) International consensus on science. Circulation 112:IV167–IV187
  2. Nadkarni VM, Larkin GL, Peberdy MA, Carey SM, Kaye W, Mancini ME, Nichol G, Lane-Truitt T, Potts J, Ornato JP, Berg RA, National Registry of Cardiopulmonary Resuscitation Investigators (2006) First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 295:50–57
    • View reference on publisher's website
    • View reference on PubMed
  3. López-Herce J, García C, Domínguez P, the Spanish Study Group of Cardiopulmonary Arrest in Children (2004) Characteristics and outcome of cardiorespiratory arrest in children. Resuscitation 63:311–313
    • View reference on publisher's website
    • View reference on PubMed
  4. Rodríguez Núñez A, López-Herce J, García C, Dominguez P, Carrillo A, Calvo C, Delgado MA, the Spanish Study Group for Cardiopulmonary Arrest in Children (2006) Effectiveness and long-term outcome of cardiopulmonary resuscitation in paediatric intensive care units in Spain. Resuscitation 71:301–309
    • View reference on publisher's website
    • View reference on PubMed
  5. Atkins DL, Everson-Stewart S, Sears GK, Daya M, Osmond MH, Warden CR, Berg RA, Resuscitation Outcomes Consortium Investigators (2009) Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the resuscitation outcomes consortium epistry-cardiac arrest. Circulation 119:1484–1491
    • View reference on publisher's website
    • View reference on PubMed
  6. Meert KL, Donaldson A, Nadkarni V, Tieves KS, Schleien CL, Brilli RJ, Clark RS, Shaffner DH, Levy F, Statler K, Dalton HJ, van der Jagt EW, Hackbarth R, Pretzlaff R, Hernan L, Dean JM, Moler FW, Pediatric Emergency Care Applied Research Network (2009) Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 10:544–553
    • View reference on publisher's website
    • View reference on PubMed
  7. Donoghue A, Berg RA, Hazinski MF, Praestgaard AH, Roberts K, Nadkarni VM, American Heart Association National Registry of CPR Investigators (2009) Cardiopulmonary resuscitation for bradycardia with poor perfusion versus pulseless cardiac arrest. Pediatrics 124:1541–1548
    • View reference on publisher's website
    • View reference on PubMed
  8. Topjian AA, Berg RA, Nadkarni VM (2008) Pediatric cardiopulmonary resuscitation: advances in science, techniques, and outcomes. Pediatrics 122:1086–1098
    • View reference on publisher's website
    • View reference on PubMed
  9. Cavus E, Bein B, Dörges V, Stadlbauer KH, Wenzel V, Steinfath M, Hanss R, Scholz J (2006) Brain tissue oxygen pressure and cerebral metabolism in an animal model of cardiac arrest and cardiopulmonary resuscitation. Resuscitation 71:97–106
    • View reference on publisher's website
    • View reference on PubMed
  10. Chien J-C, Jeng M-J, Chang H-L, Lee Y-S, Lee P-C, Soong W-J, Hwang B (2007) Cerebral oxygenation during hypoxia and resuscitation by using near-infrared spectroscospy in newborn piglets. J Chin Med Assoc 70:47–55
    • View reference on publisher's website
    • View reference on PubMed
  11. Berg RA, Hilwig RW, Kern KB, Babar I, Ewy GA (1999) Simulated mouth-to-mouth ventilation and chest compressions (bystander cardiopulmonary resuscitation) improves outcome in a swine model of prehospital pediatric asphyxial cardiac arrest. Crit Care Med 27:1893–1899
    • View reference on publisher's website
    • View reference on PubMed
  12. Berg RA, Otto CW, Kern KB, Hilwig RW, Sanders AB, Henry CP, Ewy GA (1996) A randomized, blinded trial of high-dose epinephrine versus standard-dose epinephrine in a swine model of pediatric asphyxial cardiac arrest. Crit Care Med 24:1695–1700
    • View reference on publisher's website
    • View reference on PubMed
  13. López-Herce J, Fernández B, Urbano J, Mencía S, Solana MJ, Del Castillo J, Rodriguez-Nuñez A, Bellon JM (2010) Terlipressin versus adrenaline in an infant animal model of asphyctic cardiac arrest. Intensive Care Med 36:1248–1255
  14. Engoren M, Severyn F, Fenn-Buderer N, DeFrank M (2002) Cardiac output, coronary blood flow, and blood gases during open-chest standard and compression-active-decompression cardiopulmonary resuscitation. Resuscitation 55:309–316
    • View reference on publisher's website
    • View reference on PubMed
  15. Nolan JP, Neumar RW, Adrie C, Aibiki M, Berg RA, Böttiger BW, Callaway C, Clark RS, Geocadin RG, Jauch EC, Kern KB, Laurent I, Longstreth WT, Merchant RM, Morley P, Morrison LJ, Nadkarni V, Peberdy MA, Rivers EP, Rodriguez-Nunez A, Sellke FW, Spaulding C, Sunde K, Hoek TV (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A scientific statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke. Resuscitation 79:350–379
    • View reference on publisher's website
    • View reference on PubMed
  16. Liu Z, Li Ch, Wu J, Wu C, Zhang G (2009) The impact of dopamine on hemodynamics, oxygen metabolism, and cerebral resucitation after restoration of spontaneous circulation in pigs. J Emerg Med. doi: 10.1016/j.jemermed.2009.08.049
  17. Rupérez M, López-Herce J, García C, Sánchez C, García E, Vigil D (2004) Comparison between cardiac output measured by the pulmonary arterial thermodilution technique and that measured by the femoral arterial thermodilution technique in a pediatric animal model. Pediatr Cardiol 25:119–123
    • View reference on publisher's website
    • View reference on PubMed
  18. López-Herce J, Rupérez M, Sánchez C, García C, García E (2006) Haemodynamic response to acute hypovolaemia, rapid volume expansion and adrenaline administration in an infant animal model. Resuscitation 68:259–265
    • View reference on publisher's website
    • View reference on PubMed
  19. López-Herce J, Bustinza A, Sancho L, Mencía S, Carrillo A, Moral R, Bellón JM (2009) Cardiac output and blood volume parameters using femoral arterial thermodilution. Pediatr Int 51:59–65
    • View reference on publisher's website
    • View reference on PubMed
  20. Lemson J, Backx AP, van Oort AM, Bouw TP, van der Hoeven JB (2009) Extravascular lung water measurement using transpulmonary thermodilution in children. Pediatric Crit Care Med 10:227–233
    • View reference on publisher's website
  21. Cechetti C, Lubrano R, Cristaldi S, Stoppa F, Barbieri MA, Elli M, Masciangelo R, Perrotta D, Travasso E, Raggi C, Marano M, Pirozzi N (2008) Relathionship between global end-diastolic volume and cardiac output in critically ill infants and children. Crit Care Med 36:928–932
  22. Schiffmann H, Erdlenbruch B, Singer D, Singer S, Herting E, Hoeft A, Buhre W (2002) Assessment of cardiac output, intravascular volume status, and extravascular lung water by transpulmonary indicator dilution in critically ill neonates and infants. J Cardiothorac Vasc Anesth 16:592–597
    • View reference on publisher's website
    • View reference on PubMed
  23. Gil Antón J, Cecchetti C, Menéndez S, Cambra FJ, López-Herce J, Rodríguez-Núñez A (2009) Experiencia clínica preliminar con el sistema PiCCO en niños con shock. An Pediatr (Barc) 71:135–140
    • View reference on publisher's website
  24. McLuckie A, Murdoch IA, Marsh MJ, Anderson D (1996) A comparison of pulmonary and femoral artery thermodilution cardiac indices in paediatric intensive care patients. Acta Paediatr 85:336–338
    • View reference on publisher's website
    • View reference on PubMed
  25. Nordmark J, Johanson J, Sandberg D, Granstam S-O, Huzevka T, Covaciu L, Mörtberg E, Rubertsson S (2009) Assessment of intravascular volume by transthoracic echocardiography during therapeutic hypothermia and rewarming in cardiac arrest survivors. Resuscitation 80:1234–1239
    • View reference on publisher's website
    • View reference on PubMed
  26. Krep H, Breil M, Sinn D, Hagendorff A, Hoeft A, Fischer M (2004) Effects of hypertonic versus hypotonic infusion therapy on regional cerebral blood flow after experimental cardiac arrest cardiopulmonary resuscitation in pigs. Resuscitation 63:73–83
    • View reference on publisher's website
    • View reference on PubMed
  27. Soar J (2009) Fluid infusion during CPR and after ROSC—is it safe? Resuscitation 80:1221–1222
    • View reference on publisher's website
    • View reference on PubMed
  28. Kaufman J, Almodovar MC, Zuk J, Friesen RH (2008) Correlation of abdominal site near-infrared spectroscopy with gastric tonometry in infants following surgery for congenital heart disease. Pediatr Crit Care Med 9:62–68
    • View reference on publisher's website
    • View reference on PubMed
  29. Chakravarti SB, Mittnacht AJ, Katz JC, Nguyen K, Joashi U, Srivastava S (2009) Multisite near-infrared spectroscopy predicts elevated blood lactate level in children after cardiac surgery. J Cardiothorac Vasc Anesth 23:663–667
    • View reference on publisher's website
    • View reference on PubMed
  30. Xiao F, Rodriguez J, Arnold TA, Zhang S, Ferrara D, Ewing J, Alexander JS, Carden DL, Conrad SA (2004) Near-infrared spectroscopy: a tool to monitor cerebral hemodynamic and metabolic changes after cardiac arrest in rats. Resuscitation 63:213–220
    • View reference on publisher's website
    • View reference on PubMed
  31. Calvo C, Ruza F, López-Herce J, Dorao P, Arribas N, Alvarado F (1997) Usefulness of gastric intramucosal pH for monitoring hemodynamic complications in critically ill children. Intensive Care Med 23:1268–1274
  32. Casado-Flores J, Mora E, Pérez-Corral F, Martínez-Azagra A, García-Teresa MA, Ruiz-López MJ (1998) Prognostic value of gastric intramucosal pH in critically ill children. Crit Care Med 26:1123–1127
    • View reference on publisher's website
    • View reference on PubMed
  33. de Souza RL, de Carvalho WB, Maluf MA, Carvalho AC (2001) Assessment of splanchnic perfusion with gastric tonometry in the immediate postoperative period of cardiac surgery in children. Arq Bras Cardiol 77:509–519
    • View reference on PubMed
  34. Pérez A, Schnitzler EJ, Minces PG (2000) The value of gastric intramucosal pH in the postoperative period of cardiac surgery in pediatric patients. Crit Care Med 28:1585–1589
    • View reference on publisher's website
    • View reference on PubMed

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