Abstract
BackgroundEnd-tidal CO2 (ETCO2), partial pressure of exhaled CO2 (PECO2), and volume of expired CO2 (VCO2) can be continuously monitored non-invasively to reflect pulmonary ventilation and perfusion status. Although ETCO2 ≥14mmHg has been shown to be associated with return of an adequate heart rate in neonatal resuscitation and quantifying the PECO2 has the potential to serve as an indicator of resuscitation quality, there is little information regarding capnometric measurement of PECO2 and ETCO2 in detecting return of spontaneous circulation (ROSC) and survivability in asphyxiated neonates receiving cardiopulmonary resuscitation (CPR).MethodsSeventeen newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by apnea to induce asphyxia. Protocolized resuscitation was initiated when heart rate decreased to 25% of baseline. Respiratory and hemodynamic parameters including ETCO2, PECO2, VCO2, heart rate, cardiac output, and carotid artery flow were continuously measured and analyzed.ResultsThere were no differences in respiratory and hemodynamic parameters between surviving and non-surviving piglets prior to CPR. Surviving piglets had significantly higher ETCO2, PECO2, VCO2, cardiac index, and carotid artery flow values during CPR compared to non-surviving piglets.ConclusionSurviving piglets had significantly better respiratory and hemodynamic parameters during resuscitation compared to non-surviving piglets. In addition to optimizing resuscitation efforts, capnometry can assist by predicting outcomes of newborns requiring chest compressions.
Highlights
Neonatal asphyxia is a common cause of mortality and morbidity and worldwide contributes to approximately 1 million deaths annually
Surviving piglets had significantly higher End-tidal CO2 (ETCO2), pressure of exhaled CO2 (PECO2), volume of expired CO2 (VCO2), cardiac index, and carotid artery flow values during cardiopulmonary resuscitation (CPR) compared to nonsurviving piglets
In addition to optimizing resuscitation efforts, capnometry can assist by predicting outcomes of newborns requiring chest compressions
Summary
Neonatal asphyxia is a common cause of mortality and morbidity and worldwide contributes to approximately 1 million deaths annually. End-tidal CO2 (ETCO2) is the level of CO2 at the end of an exhaled breath and is mainly determined by alveolar ventilation, pulmonary perfusion (right ventricular output), and total body CO2 production due to metabolism [3]. Observing changing levels of ETCO2, which reflect changes in pulmonary blood flow, while delivering chest compressions (CC) and ventilations has proven to be useful in determining circulatory status during cardiac arrest and resuscitation in human adults [6]. ETCO2 14mmHg has been shown to be associated with return of an adequate heart rate in neonatal resuscitation and quantifying the PECO2 has the potential to serve as an indicator of resuscitation quality, there is little information regarding capnometric measurement of PECO2 and ETCO2 in detecting return of spontaneous circulation (ROSC) and survivability in asphyxiated neonates receiving cardiopulmonary resuscitation (CPR)
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