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  • Heart rate changes during positive pressure ventilation after asphyxia-induced bradycardia in a porcine model of neonatal resuscitation

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Heart rate changes during positive pressure ventilation after asphyxia-induced bradycardia in a porcine model of neonatal resuscitation
  1. Maria Liza Espinoza1,2,
  2. Po-Yin Cheung2,3,
  3. Tze-Fun Lee2,3,
  4. Megan O’Reilly2,3,
  5. Georg M Schmölzer2,3
  1. 1 Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
  2. 2 Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
  3. 3 Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr Georg M Schmölzer, Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada; georg.schmoelzer{at}me.com

Abstract

Background The Neonatal Resuscitation Program (NRP) states that if adequate positive pressure ventilation (PPV) was given for a low heart rate (HR), the infant’s HR should increase within the first 15 s of PPV.

Objective To assess changes in HR in piglets with asphyxia-induced bradycardia.

Methods Term newborn piglets (n=30) were anaesthetised, intubated, instrumented and exposed to 50 min normocapnic hypoxia followed by asphyxia. Asphyxia was achieved by clamping the tube until severe bradycardia (defined as HR at <25% of baseline). This was followed by 30 s adequate PPV and chest compression thereafter. Changes in HR during the 30 s of PPV were assessed and divided into four epochs (0–10 s, 5–15 s, 10–20 s and 20–30 s, respectively).

Results Increase in HR >100/min was observed in 6/30 (20%) after 30 s of PPV. Within the epochs 0–10 s, 5–15 s or 10–20 s no piglet had an increase in HR >100/min. Additional 10/30 (33%) had a >10% increase in HR.

Conclusion In contrast to NRP recommendation, adequate PPV does not increase HR within 15 s after ventilation in piglets with asphyxia-induced bradycardia.

  • newborn
  • infants
  • neonatal resuscitation
  • asphyxia
  • heart rate

https://doi.org/10.1136/archdischild-2017-314637

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    Footnotes

    • Contributors Conception and design: GMS, PYC. Drafting of the article: MLE, GMS, PYC, TFL, MOR. Critical revision of the article for important intellectual content: MLE, GMS, PYC, TFL, MOR. Final approval of the article: MLE, GMS, PYC, TFL, MOR.

    • Funding This study was funded by the Women and Children’s Health Research Institute, Edmonton, Alberta; Heart and Stroke Foundation of Alberta; Heart and Stroke Foundation of Canada; Neonatal Resuscitation Program; and Canadian Paediatric Society.

    • Disclaimer The sponsors of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report.

    • Competing interests None declared.

    • Ethics approval Animal Care and Use Committee (Health Sciences), University of Alberta (AUP00000237)

    • Provenance and peer review Not commissioned; externally peer reviewed.

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