Background and Aims

To compare early intubation vs bag-valve-mask ventilation (BVMV), and expiratory tidal volume (Vte) real-time guide ventilation vs standard ventilation (non-guidance ventilation) in a pediatric animal model of asphyxial cardiac arrest (CA).

Methods

Piglets were randomized into five groups: 1: intubated and Vte-guided ventilation (10 ml/kg); 2: intubated and standard ventilation (SV); 3: BVMV and Vte-guided ventilation (10 ml/kg); 4: BVMV and standard ventilation; 5: intubated and Vte-guided ventilation (7 ml/kg). To give 30 breaths-per-minute a metronome was used. Return of spontaneous circulation (ROSC) were compared between groups. A linear mixed model was performed to analysed EtCO2 (end tidal CO2), VCO2 (CO2 output), MAP (mean arterial pressure), DAP (diastolic arterial pressure) and VTe during resuscitation.

Results

Seventy-nine piglets weighing 11.3±1.2 kg were included. Twenty-six (32.9%) achieved ROSC (group 1: 41.2%; group 2: 40.0%; group 3: 23.5%; group 4: 20% and group 5: 40%). Survival rate was higher in intubated piglets (40.4%) than BVMV (21.9%), p=0.08. No differences in ROSC were found between VTe-guided (30%) and SV (34.7%) p=0.67). ROSC animals, presented higher EtCO2, VCO2, MAP and DAP during resuscitation, than non-survivors (p<0.01) (figure 1). Intubated animals compared to BVMV presented higher EtCO2, VCO2 and Vte (p<0.04) throughout resuscitation (figure 1). Vte were lower in Vte-guided group than in SV (p<0.01).

Figure 1 Linear mixed model

Conclusions

In an animal model of pediatric CA, early intubation obtained higher non-significant survival rates. Vte was higher in intubated animals and with SV. Better ETCO2, VCO2, MAP and DAP were achieved in ROSC animals.