Abstract
The main aim of this paper was to provide an overview of studies that measured cerebral blood flow (CBF), directly or indirectly, during chest compression (CC) in neonatal animals. Our main research question was: how did different ways of performing CC influence CBF. We also aimed to discuss strengths and limitations of different methods for measuring CBF. Based on a search in Medline Ovid, we identified three studies in piglets that investigated different CC:ventilation (C:V) ratios, as well as three piglet studies investigating continuous CC with asynchronous ventilation. CBF was measured indirectly in all studies by means of carotid artery (CA) flow and regional cerebral oxygenation (rcSO2). The CA provides flow to the brain, but also to extracerebral structures. The relative sizes of the internal and external carotid arteries and their flow distributions are species-dependent. rcSO2 is a non-invasive continuous measure, but does not only reflect CBF, but also cerebral blood volume and the metabolic rate of oxygen in the brain. Continuous CC with asynchronous ventilation at a CC rate of 120/min, and combining CC with a sustained inflation (four studies in piglets and one in lambs) provided a faster CBF recovery compared with the standard 3:1 C:V approach.
Highlights
Cerebral hypoxemia results in reduced cerebral vascular resistance and increased cerebral blood flow (CBF) [1]
Oxygen delivery to the brain depends on cerebral hemodynamics including CBF and cerebral blood flow velocity (CBFV)
Due to the low number of studies in neonatal animals, we included some studies in non-neonatal animal models
Summary
Cerebral hypoxemia results in reduced cerebral vascular resistance and increased cerebral blood flow (CBF) [1]. This compensates for the decreased blood oxygen content during the initial phase of perinatal asphyxia. When the asphyxial process continues, cardiac output and systemic blood pressure falls and compensatory mechanisms fall short with resulting cerebral hypoxia-ischemia. Oxygen delivery to the brain depends on cerebral hemodynamics including CBF and cerebral blood flow velocity (CBFV). Blood oxygen content as determined by fraction of inspired oxygen (FiO2 ), pulmonary gas exchange and haemoglobin (Hb) concentration influence cerebral oxygen delivery [2]. In cardiac arrest, assisted ventilation and chest compression (CC) is needed to maintain cerebral oxygen delivery [3]
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