Simulated mouth-to-mouth ventilation and chest compressions (bystander cardiopulmonary resuscitation) improves outcome in a swine model of prehospital pediatric asphyxial cardiac arrest

Robert A. Berg, Ronald W. Hilwig, Karl B Kern, Ijlal Babar, Gordon A. Ewy

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

Objective: To compare the efficacy of four methods of simulated single- rescuer bystander cardiopulmonary resuscitation (CPR) in a clinically relevant swine model of prehospital pediatric asphyxial cardiac arrest. Design: Prospective, randomized study. Subjects: Thirty-nine anesthetized domestic piglets. Interventions: Asphyxial cardiac arrest was produced by clamping the endotracheal tubes of the piglets. For 8 mins of simulated bystander CPR, animals were randomly assigned to the following groups: group 1, chest compressions and simulated mouth-to-mouth ventilation (FIO2 = 0.17, FICO2 = 0.04) (CC+V); group 2, chest compressions only (CC); group 3, simulated mouth-to-mouth ventilation only (V); and group 4, no CPR (control group). Standard advanced life support was then provided, simulating paramedic arrival. Animals that were successfully resuscitated received 1 hr of intensive care support and were observed for 24 hrs. Measurements and Main Results: Electrocardiogram, aortic blood pressure, right atrial blood pressure, and end-tidal CO2 were monitored continuously until the intensive care period ended. Arterial and mixed venous blood gases were measured at baseline, 1 min after cardiac arrest, and 7 mins after cardiac arrest. Minute ventilation was determined during each minute of bystander CPR. Survival and neurologic outcome were determined. Twenty-four-hour survival was attained in eight of 10 group 1 (CC+V) piglets vs. three of 14 group 2 (CC) piglets (p ≤ .01), one of seven group 3 (V) piglets (p ≤ .05), and two of eight group 4 (control) piglets (p ≤ .05). Twenty-four-hour neurologically normal survival occurred in seven of 10 group 1 (CC+V) piglets vs. one of 14 group 2 (CC) piglets (p ≤ .01), one of seven group 3 (V) piglets (p ≤ .05), and none of eight group 4 (control) piglets (p ≤ .01). Arterial oxygenation and pH were markedly better during CPR in group 1 than in group 2. Within 5 mins of bystander CPR, six of 10 group 1 (CC+V) piglets attained sustained return of spontaneous circulation vs. only two of 14 group 2 (CC) piglets and none of the piglets in the other two groups (p ≤ .05 for all groups). Conclusions: In this pediatric asphyxial model of prehospital single-rescuer bystander CPR, chest compressions plus simulated mouth-to-mouth ventilation improved systemic oxygenation, coronary perfusion pressures, early return of spontaneous circulation, and 24-hr survival compared with the other three approaches.

Original languageEnglish (US)
Pages (from-to)1893-1899
Number of pages7
JournalCritical Care Medicine
Volume27
Issue number9
DOIs
StatePublished - 1999

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Cardiopulmonary Resuscitation
Heart Arrest
Ventilation
Mouth
Swine
Thorax
Pediatrics
Critical Care
Control Groups
Allied Health Personnel
Atrial Pressure
Constriction
Nervous System
Arterial Pressure
Electrocardiography
Perfusion
Gases
Prospective Studies
Blood Pressure
Pressure

Keywords

  • Asphyxia
  • Cardiopulmonary resuscitation
  • Children
  • Heart arrest
  • Neurologic outcome
  • Pediatrics
  • Pulmonary ventilation
  • Survival
  • Swine
  • Ventilation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Simulated mouth-to-mouth ventilation and chest compressions (bystander cardiopulmonary resuscitation) improves outcome in a swine model of prehospital pediatric asphyxial cardiac arrest. / Berg, Robert A.; Hilwig, Ronald W.; Kern, Karl B; Babar, Ijlal; Ewy, Gordon A.

In: Critical Care Medicine, Vol. 27, No. 9, 1999, p. 1893-1899.

Research output: Contribution to journalArticle

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abstract = "Objective: To compare the efficacy of four methods of simulated single- rescuer bystander cardiopulmonary resuscitation (CPR) in a clinically relevant swine model of prehospital pediatric asphyxial cardiac arrest. Design: Prospective, randomized study. Subjects: Thirty-nine anesthetized domestic piglets. Interventions: Asphyxial cardiac arrest was produced by clamping the endotracheal tubes of the piglets. For 8 mins of simulated bystander CPR, animals were randomly assigned to the following groups: group 1, chest compressions and simulated mouth-to-mouth ventilation (FIO2 = 0.17, FICO2 = 0.04) (CC+V); group 2, chest compressions only (CC); group 3, simulated mouth-to-mouth ventilation only (V); and group 4, no CPR (control group). Standard advanced life support was then provided, simulating paramedic arrival. Animals that were successfully resuscitated received 1 hr of intensive care support and were observed for 24 hrs. Measurements and Main Results: Electrocardiogram, aortic blood pressure, right atrial blood pressure, and end-tidal CO2 were monitored continuously until the intensive care period ended. Arterial and mixed venous blood gases were measured at baseline, 1 min after cardiac arrest, and 7 mins after cardiac arrest. Minute ventilation was determined during each minute of bystander CPR. Survival and neurologic outcome were determined. Twenty-four-hour survival was attained in eight of 10 group 1 (CC+V) piglets vs. three of 14 group 2 (CC) piglets (p ≤ .01), one of seven group 3 (V) piglets (p ≤ .05), and two of eight group 4 (control) piglets (p ≤ .05). Twenty-four-hour neurologically normal survival occurred in seven of 10 group 1 (CC+V) piglets vs. one of 14 group 2 (CC) piglets (p ≤ .01), one of seven group 3 (V) piglets (p ≤ .05), and none of eight group 4 (control) piglets (p ≤ .01). Arterial oxygenation and pH were markedly better during CPR in group 1 than in group 2. Within 5 mins of bystander CPR, six of 10 group 1 (CC+V) piglets attained sustained return of spontaneous circulation vs. only two of 14 group 2 (CC) piglets and none of the piglets in the other two groups (p ≤ .05 for all groups). Conclusions: In this pediatric asphyxial model of prehospital single-rescuer bystander CPR, chest compressions plus simulated mouth-to-mouth ventilation improved systemic oxygenation, coronary perfusion pressures, early return of spontaneous circulation, and 24-hr survival compared with the other three approaches.",
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T1 - Simulated mouth-to-mouth ventilation and chest compressions (bystander cardiopulmonary resuscitation) improves outcome in a swine model of prehospital pediatric asphyxial cardiac arrest

AU - Berg, Robert A.

AU - Hilwig, Ronald W.

AU - Kern, Karl B

AU - Babar, Ijlal

AU - Ewy, Gordon A.

PY - 1999

Y1 - 1999

N2 - Objective: To compare the efficacy of four methods of simulated single- rescuer bystander cardiopulmonary resuscitation (CPR) in a clinically relevant swine model of prehospital pediatric asphyxial cardiac arrest. Design: Prospective, randomized study. Subjects: Thirty-nine anesthetized domestic piglets. Interventions: Asphyxial cardiac arrest was produced by clamping the endotracheal tubes of the piglets. For 8 mins of simulated bystander CPR, animals were randomly assigned to the following groups: group 1, chest compressions and simulated mouth-to-mouth ventilation (FIO2 = 0.17, FICO2 = 0.04) (CC+V); group 2, chest compressions only (CC); group 3, simulated mouth-to-mouth ventilation only (V); and group 4, no CPR (control group). Standard advanced life support was then provided, simulating paramedic arrival. Animals that were successfully resuscitated received 1 hr of intensive care support and were observed for 24 hrs. Measurements and Main Results: Electrocardiogram, aortic blood pressure, right atrial blood pressure, and end-tidal CO2 were monitored continuously until the intensive care period ended. Arterial and mixed venous blood gases were measured at baseline, 1 min after cardiac arrest, and 7 mins after cardiac arrest. Minute ventilation was determined during each minute of bystander CPR. Survival and neurologic outcome were determined. Twenty-four-hour survival was attained in eight of 10 group 1 (CC+V) piglets vs. three of 14 group 2 (CC) piglets (p ≤ .01), one of seven group 3 (V) piglets (p ≤ .05), and two of eight group 4 (control) piglets (p ≤ .05). Twenty-four-hour neurologically normal survival occurred in seven of 10 group 1 (CC+V) piglets vs. one of 14 group 2 (CC) piglets (p ≤ .01), one of seven group 3 (V) piglets (p ≤ .05), and none of eight group 4 (control) piglets (p ≤ .01). Arterial oxygenation and pH were markedly better during CPR in group 1 than in group 2. Within 5 mins of bystander CPR, six of 10 group 1 (CC+V) piglets attained sustained return of spontaneous circulation vs. only two of 14 group 2 (CC) piglets and none of the piglets in the other two groups (p ≤ .05 for all groups). Conclusions: In this pediatric asphyxial model of prehospital single-rescuer bystander CPR, chest compressions plus simulated mouth-to-mouth ventilation improved systemic oxygenation, coronary perfusion pressures, early return of spontaneous circulation, and 24-hr survival compared with the other three approaches.

AB - Objective: To compare the efficacy of four methods of simulated single- rescuer bystander cardiopulmonary resuscitation (CPR) in a clinically relevant swine model of prehospital pediatric asphyxial cardiac arrest. Design: Prospective, randomized study. Subjects: Thirty-nine anesthetized domestic piglets. Interventions: Asphyxial cardiac arrest was produced by clamping the endotracheal tubes of the piglets. For 8 mins of simulated bystander CPR, animals were randomly assigned to the following groups: group 1, chest compressions and simulated mouth-to-mouth ventilation (FIO2 = 0.17, FICO2 = 0.04) (CC+V); group 2, chest compressions only (CC); group 3, simulated mouth-to-mouth ventilation only (V); and group 4, no CPR (control group). Standard advanced life support was then provided, simulating paramedic arrival. Animals that were successfully resuscitated received 1 hr of intensive care support and were observed for 24 hrs. Measurements and Main Results: Electrocardiogram, aortic blood pressure, right atrial blood pressure, and end-tidal CO2 were monitored continuously until the intensive care period ended. Arterial and mixed venous blood gases were measured at baseline, 1 min after cardiac arrest, and 7 mins after cardiac arrest. Minute ventilation was determined during each minute of bystander CPR. Survival and neurologic outcome were determined. Twenty-four-hour survival was attained in eight of 10 group 1 (CC+V) piglets vs. three of 14 group 2 (CC) piglets (p ≤ .01), one of seven group 3 (V) piglets (p ≤ .05), and two of eight group 4 (control) piglets (p ≤ .05). Twenty-four-hour neurologically normal survival occurred in seven of 10 group 1 (CC+V) piglets vs. one of 14 group 2 (CC) piglets (p ≤ .01), one of seven group 3 (V) piglets (p ≤ .05), and none of eight group 4 (control) piglets (p ≤ .01). Arterial oxygenation and pH were markedly better during CPR in group 1 than in group 2. Within 5 mins of bystander CPR, six of 10 group 1 (CC+V) piglets attained sustained return of spontaneous circulation vs. only two of 14 group 2 (CC) piglets and none of the piglets in the other two groups (p ≤ .05 for all groups). Conclusions: In this pediatric asphyxial model of prehospital single-rescuer bystander CPR, chest compressions plus simulated mouth-to-mouth ventilation improved systemic oxygenation, coronary perfusion pressures, early return of spontaneous circulation, and 24-hr survival compared with the other three approaches.

KW - Asphyxia

KW - Cardiopulmonary resuscitation

KW - Children

KW - Heart arrest

KW - Neurologic outcome

KW - Pediatrics

KW - Pulmonary ventilation

KW - Survival

KW - Swine

KW - Ventilation

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