Abstract 165: 21% Or 100% Oxygen During Cardiopulmonary Resuscitation in Asphyxiated Pediatric Piglets - A Randomized Controlled Animal Study

Abstract

Background: Current pediatric resuscitation guidelines recommend 100% oxygen (O 2 ) during cardiopulmonary resuscitation (CPR), however the most effective O 2 concentration for pediatric patients remains unknown. Aim: To determine if 21%O 2 during CPR with either chest compression (CC) during sustained inflation (SI) (CC+SI) or continuous chest compression with asynchronized ventilation (CCaV) will reduce time to return of spontaneous circulation (ROSC) compared to 100%O 2 in pediatric piglets with asphyxia-induced cardiac arrest. Methods: Piglets (20-23 days of age, weighing 6.2-10.2 kg) were anesthetized, intubated, instrumented, and exposed to asphyxia. Cardiac arrest was defined as mean arterial blood pressure <25 mmHg with bradycardia. After cardiac arrest, piglets were randomized to CC+SI or CCaV with either 21% or 100%O 2 or sham. Heart rate, arterial blood pressure, carotid blood flow, and respiratory parameters were continuously recorded. Results: There were no differences in baseline parameters or the duration and degree of asphyxiation. Median (interquartile range) time to ROSC was 107 (90-440) and 140 (105-200) sec with CC+SI 21% and 100%O 2 and 600 (50-600) and 600 (95-600)sec with CCaV 21% and 100%O 2 (p=0.27). Overall, 6 (86%) and 6 (86%) with CC+SI 21% and 100%O 2 and 3 (43%) and 3 (43%) achieved ROSC with CCaV 21% and 100%O 2 (p=0.13). Conclusions: In pediatric piglets resuscitated with 21% oxygen compared to 100% oxygen, using either CCaV or CC+SI had similar time to ROSC and survival. CPR using CC+SI had shorter time to ROSC and higher survival compared to CCaV. Clinical studies comparing 21% with 100%O 2 during pediatric CPR are warranted.