nach oben

Erschienen in:

01.01.2011 | Experimental

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

verfasst von: Jesús López-Herce, Bárbara Fernández, Javier Urbano, Santiago Mencía, Maria José Solana, Antonio Rodríguez-Núñez, Jose María Bellón, Angel Carrillo

Erschienen in: Intensive Care Medicine | Ausgabe 1/2011

Einloggen, um Zugang zu erhalten

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.

Nur mit Berechtigung zugänglich

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

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 295:50–57CrossRefPubMed

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 63:311–313CrossRefPubMed

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 71:301–309CrossRefPubMed

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 119:1484–1491CrossRefPubMed

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 10:544–553CrossRefPubMed

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 124:1541–1548CrossRefPubMed

Topjian AA, Berg RA, Nadkarni VM (2008) Pediatric cardiopulmonary resuscitation: advances in science, techniques, and outcomes. Pediatrics 122:1086–1098CrossRefPubMed

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 71:97–106CrossRefPubMed

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 70:47–55CrossRefPubMed

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 27:1893–1899CrossRefPubMed

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 24:1695–1700CrossRefPubMed

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 55:309–316CrossRefPubMed

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 79:350–379CrossRefPubMed

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 25:119–123CrossRefPubMed

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 68:259–265CrossRefPubMed

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 51:59–65CrossRefPubMed

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 10:227–233CrossRef

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 16:592–597CrossRefPubMed

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) 71:135–140CrossRef

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 85:336–338CrossRefPubMed

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 80:1234–1239CrossRefPubMed

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 63:73–83CrossRefPubMed

27.

Soar J (2009) Fluid infusion during CPR and after ROSC—is it safe? Resuscitation 80:1221–1222CrossRefPubMed

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 9:62–68CrossRefPubMed

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 23:663–667CrossRefPubMed

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 63:213–220CrossRefPubMed

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 23:1268–1274CrossRefPubMed

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 26:1123–1127CrossRefPubMed

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 77:509–519PubMed

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 28:1585–1589CrossRefPubMed

Titel: Hemodynamic, respiratory, and perfusion parameters during asphyxia, resuscitation, and post-resuscitation in a pediatric model of cardiac arrest
verfasst von: Jesús López-Herce
Bárbara Fernández
Javier Urbano
Santiago Mencía
Maria José Solana
Antonio Rodríguez-Núñez
Jose María Bellón
Angel Carrillo
Publikationsdatum: 01.01.2011
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 1/2011
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-010-2006-2

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

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