Abstract
AimWe recently demonstrated that asphyxiated piglets commonly had bradycardia displayed on electrocardiography (ECG) while no carotid blood flow (CBF) or audible heart sounds could be detected. Such pulseless electrical activity (PEA) in newborn infants has not previously been thoroughly described. The aim of this study was to further investigate the occurrence of non-perfusing cardiac rhythms in asphyxiated piglets and the potential implications for the success of cardiopulmonary resuscitation (CPR) and short-term survival.MethodsNeonatal piglets (1–4 days, 1.7–2.4kg) had their right common carotid artery exposed and enclosed with a real-time ultrasonic flow probe. Heart rate (HR) was continuously measured and recorded using ECG. This allowed simultaneous monitoring of HR via ECG and CBF. The piglets were asphyxiated until cardiac arrest, defined as no CBF and no audible beat upon precordial auscultation. CPR was performed until return of spontaneous circulation (ROSC, defined as a HR ≥100 bpm). ECG traces were retrospectively assessed.ResultsNine out of 21 piglets (43%) had QRS-complexes on their ECG while no CBF and no audible heart sounds could be detected. Five (56%) of the piglets with PEA and 12/12 (100%) piglets with asystole at cardiac arrest obtained ROSC (p = 0.02). Thirty-three per cent of the piglets with PEA versus 58% with asystole survived to 4 hours post-ROSC (p = 0.39).ConclusionCardiac arrest in the presence of a non-perfusing cardiac rhythm on ECG is common in asphyxiated piglets. Clinical arrest in the presence of a non-perfusing cardiac rhythm on ECG may reduce the success of CPR.
Highlights
Adult out-of-hospital cardiac arrests (OHCA) are commonly of primary cardiac origin with ventricular fibrillation (VF) as the cause of arrest
Thirty-three per cent of the piglets with pulseless electrical activity (PEA) versus 58% with asystole survived to 4 hours post-return of spontaneous circulation (ROSC) (p = 0.39)
Cardiac arrest in the presence of a non-perfusing cardiac rhythm on ECG is common in asphyxiated piglets
Summary
Adult out-of-hospital cardiac arrests (OHCA) are commonly of primary cardiac origin with ventricular fibrillation (VF) as the cause of arrest. Rhythm diagnosis and defibrillation are important features of adult cardiopulmonary resuscitation (CPR) [1]. Even less direct evidence exists, and guidelines for neonatal resuscitation are rather simplified compared to adult guidelines; e.g., adrenaline (epinephrine) is the only drug in the neonatal resuscitation algorithm [6, 7]. Antiarrhythmic medications, such as amiodarone and lidocaine, or defibrillation are not considered during neonatal CPR; mainly because shockable arrhythmias such as VF and pulseless ventricular tachycardia (pVT) have not been recognized in newborn infants with cardiac arrest
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
