Abstract
Background: Evidence for recommendations on the use of volume expansion during cardiopulmonary resuscitation in newborn infants is limited.Objectives: To develop a newborn piglet model with asphyxia, hemorrhage, and cardiac arrest to test different volume resuscitation on return of spontaneous circulation (ROSC). We hypothesized that immediate red cell transfusion reduces time to ROSC as compared to the use of an isotonic crystalloid fluid.Methods: Forty-four anaesthetized and intubated newborn piglets [age 32 h (12–44 h), weight 1,220 g (1,060–1,495g), Median (IQR)] were exposed to hypoxia and blood loss until asystole occurred. At this point they were randomized into two groups: (1) Crystalloid group: receiving isotonic sodium chloride (n = 22). (2) Early transfusion group: receiving blood transfusion (n = 22). In all other ways the piglets were resuscitated according to ILCOR 2015 guidelines [including respiratory support, chest compressions (CC) and epinephrine use]. One hour after ROSC piglets from the crystalloid group were randomized in two sub-groups: late blood transfusion and infusion of isotonic sodium chloride to investigate the effects of a late transfusion on hemodynamic parameters.Results: All animals achieved ROSC. Comparing the crystalloid to early blood transfusion group blood loss was 30.7 ml/kg (22.3–39.6 ml/kg) vs. 34.6 ml/kg (25.2–44.7 ml/kg), Median (IQR). Eleven subjects did not receive volume expansion as ROSC occurred rapidly. Thirty-three animals received volume expansion (16 vs. 17 in the crystalloid vs. early transfusion group). 14.1% vs. 10.5% of previously extracted blood volume in the crystalloid vs. early transfusion group was infused before ROSC. There was no significant difference in time to ROSC between groups [crystalloid group: 164 s (129–198 s), early transfusion group: 163 s (162–199 s), Median (IQR)] with no difference in epinephrine use.Conclusions: Early blood transfusion compared to crystalloid did not reduce time to ROSC, although our model included only a moderate degree of hemorrhage and ROSC occurred early in 11 subjects before any volume resuscitation occurred.
Highlights
Adequate ventilation is the key for an effective resuscitation in the delivery room, some newborns require further assistance such as chest compressions (CC), epinephrine and in specific cases even volume resuscitation in particular in the context of neonatal shock (1)
Impaired placental function resulting in fetal asphyxia as well as hypovolemia secondary to fetal blood loss and sepsis are factors contributing to poor conditions at birth (2, 3)
ILCOR guidelines recommend volume replacement using blood or isotonic crystalloid solution (4), if the newborn infant does not respond to ventilation and CPR and this may be lifesaving (2)
Summary
Adequate ventilation is the key for an effective resuscitation in the delivery room, some newborns require further assistance such as chest compressions (CC), epinephrine and in specific cases even volume resuscitation in particular in the context of neonatal shock (1). ILCOR guidelines recommend volume replacement using blood or isotonic crystalloid solution (4), if the newborn infant does not respond to ventilation and CPR and this may be lifesaving (2). O-negative, CMV-negative blood is not readily available in all delivery services but may be arranged if considered necessary. In some of these cases placental blood transfusion may be used, as this may be readily available, data is limited to few retrospective observations as prospective studies are extremely difficult (2) (Table 1). Based on our established model of asphyxia (15) we added a component of standardized hemorrhage to evaluate different volume resuscitation strategies in neonatal piglets. Evidence for recommendations on the use of volume expansion during cardiopulmonary resuscitation in newborn infants is limited
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