The use of pressure‐controlled mechanical ventilation in a swine model of intraoperative pediatric cardiac arrest

• Published in: Pediatric anesthesia 2020-04, Vol.30 (4), p.462-468
• Main Authors: Lapid, Francis M., O'Brien, Caitlin E., Kudchadkar, Sapna R., Lee, Jennifer K., Hunt, Elizabeth A., Koehler, Raymond C., Shaffner, Donald H., Ramamoorthy, Chandra
• Format: Article
• Language: English
• Subjects: Animals; artificial respiration; asphyxia; Cardiac arrest; Cardiopulmonary resuscitation; child; CPR; Disease Models, Animal; Heart Arrest - therapy; Intraoperative Complications - therapy; Pediatrics; Pediatrics - methods; Respiration, Artificial - methods; Retrospective Studies; Swine; Treatment Outcome
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.13820

Background Current pediatric resuscitation guidelines suggest that resuscitators using an advanced airway deliver 8‐10 breaths per minute while carefully avoiding excessive ventilation. In the intraoperative setting, having a dedicated ventilation rescuer may be difficult because of limited personnel. Continuing pressure‐controlled mechanical ventilation during resuscitation for intraoperative cardiac arrest reduces personnel needed and the risk of hyperventilation but might risk hypoventilation during chest compression delivery. Aims To determine whether the use of pressure‐controlled mechanical ventilation at prearrest settings provides normoxia and normocarbia during resuscitation from cardiac arrest. Methods We retrospectively analyzed combined data from preclinical randomized controlled trials. Two‐week‐old swine (3‐4 kg) underwent asphyxia‐induced cardiac arrest. Animals were resuscitated with periods of basic and advanced life support. During resuscitation, pressure‐controlled mechanical ventilation was delivered at the prearrest respiratory rate, peak inspiratory pressure, and positive end‐expiratory pressure. Arterial blood gases were measured prearrest, at 11 minutes of asphyxia, and at 8 and 20 minutes of cardiopulmonary resuscitation. Results Piglets (n = 154) received pressure‐controlled mechanical ventilation before and during cardiopulmonary resuscitation with a peak inspiratory pressure of 14‐15 cm H2O, positive end‐expiratory pressure of 4 cm H2O, 20 breaths/minute, and an inspiratory:expiratory ratio of 1:2. During asphyxia, the arterial blood gas showed the expected severe hypercarbia and hypoxia. Continuing pressure‐controlled mechanical ventilation using prearrest parameters and increasing the FiO2 to 1.0 returned the PaCO2 to prearrest levels and slightly increased the partial pressure of arterial oxygen at 8 and 20 minutes of cardiopulmonary resuscitation. Conclusion In this piglet model of resuscitation from asphyxial arrest, pressure‐controlled mechanical ventilation during cardiopulmonary resuscitation at the prearrest ventilator settings with an FiO2 of 1.0 provides adequate oxygenation and restores normocarbia. Clinical investigation is warranted to determine the benefits of continuing pressure‐controlled mechanical ventilation at prearrest parameters during pediatric cardiopulmonary resuscitation.