Asynchronous ventilation at 120 compared with 90 or 100 compressions per minute improves haemodynamic recovery in asphyxiated newborn piglets

Objective To determine whether different chest compression (CC) rates during continuous CC with asynchronous ventilations (CCaV) reduce time to return of spontaneous circulation (ROSC) and improved haemodynamic recovery in piglets aged 24-72 hours with asphyxia-induced asystole. Methods Thirty piglets (aged 24-72 hours) were anaesthetised, intubated, instrumented and exposed to 30 min normocapnic hypoxia followed by asphyxia. Piglets were randomised into four groups: CCaV with CC rate of 90 (CCaV+90, n=8), 100 (CCaV+100, n=8) or 120 compressions per minute (CCaV+120, n=8), and a sham-operated group (n=6). Cardiac function, carotid blood flow, cerebral and renal oxygenation and respiratory parameters were continuously recorded. Cerebral cortical tissue was harvested and assayed for inflammatory and injury markers. Results All three intervention groups had a similar number of piglets achieving ROSC (6/8, 5/8 and 5/8 for CCaV+120, CCaV+100 and CCaV+90, respectively) and mean ROSC time (120, 90 and 90 s for CCaV+120, CCaV+100 and CCaV+90, respectively). The haemodynamic recovery (indicated by carotid flow, cerebral and renal perfusion) was similar between CCaV+120 and sham by the end of experiment. In comparison, CCaV+90 and CCaV+100 had significantly reduced haemodynamic recovery compared with sham operated (p=0.05). Inflammatory (interleukin [IL]-6 and IL-1 beta) and injury markers (lactate) were significantly higher in the frontoparietal cortex of CCaV+90 and CCaV+100 compared with sham, whereas brain injury markers were similar between CCaV+120 and sham. Conclusions Although there was no difference between the groups in achieving ROSC, the haemodynamic recovery of CCaV+120 was significantly improved compared with CCaV+90 and CCaV+100, which were also associated with higher cerebral inflammatory and brain injury markers.