Optimal oxygen use in neonatal advanced cardiopulmonary resuscitation-a literature review.

Pediatric medicine (Hong Kong, China) Pub Date : 2023-05-30 Epub Date: 2022-02-21 DOI:10.21037/pm-21-74
Deepika Sankaran, Munmun Rawat, Satyan Lakshminrusimha
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Abstract

Background and objectives: Oxygen (O2) use during neonatal cardiopulmonary resuscitation (CPR) remains a subject of controversy. The inspired O2 concentration during neonatal CPR, that hastens return of spontaneous circulation (ROSC), allows adequate cerebral and myocardial O2 delivery, and enhances survival to discharge, is not known. The optimal FiO2 during CPR should decrease incidence of hypoxia but also avoid hyperoxia, and ultimately lead to improved neurodevelopmental outcomes. Due to infrequent need for extensive resuscitation, and emergent circumstances surrounding neonatal CPR, conducting randomized clinical trials continues to be a challenge. The goal of this study was to review the evolution of oxygen use during neonatal CPR, the evidence from animal and clinical studies on oxygen use during neonatal CPR and after ROSC, the pertinent physiology including myocardial oxygen consumption and cerebral oxygen delivery during CPR, and outcomes following CPR in the DR and in the neonatal intensive care unit.

Methods: This narrative review is based on recent and historic English literature in PubMed and Google scholar over the past 35 years (January 1, 1985 - May 1, 2021).

Key content and findings: Several studies in animal models have compared ventilation with different inspired O2 concentrations (mostly 21% and 100%) during chest compressions and after ROSC. These studies reported no difference in short-term outcomes, even with as low as 18% O2. However, in lamb models of cardiac arrest and CPR, 100% O2 during chest compressions is associated with better oxygen delivery to the brain compared to 21% O2. Abrupt weaning to 21% O2 following ROSC followed by titration to achieve preductal SpO2 of 85-95% minimizes systemic hyperoxia and oxidative stress compared to slow weaning from 100% O2 following ROSC.

Conclusions: Clinical research is needed to arrive at the best strategy for assessment of oxygenation and choice of FiO2 during neonatal CPR that lead to improved survival and outcomes. In this article, we have reviewed the literature on evidence behind O2 use during neonatal advanced CPR and after ROSC.

新生儿晚期心肺复苏的最佳氧使用——文献综述
背景和目的:新生儿心肺复苏(CPR)过程中氧气(O2)的使用仍存在争议。新生儿心肺复苏过程中的吸入氧气浓度可加快自发性循环(ROSC)的恢复,使大脑和心肌获得充足的氧气,并提高出院后的存活率,但目前尚不清楚。心肺复苏过程中的最佳 FiO2 既能降低缺氧发生率,又能避免高氧,最终改善神经发育结果。由于不经常需要进行广泛的复苏,而且新生儿心肺复苏时情况紧急,因此进行随机临床试验仍然是一项挑战。本研究的目的是回顾新生儿心肺复苏期间氧气使用的演变、新生儿心肺复苏期间和复苏后氧气使用的动物和临床研究证据、相关生理学(包括心肺复苏期间的心肌耗氧量和脑供氧量)以及在 DR 和新生儿重症监护室进行心肺复苏后的预后:本叙述性综述基于过去 35 年(1985 年 1 月 1 日至 2021 年 5 月 1 日)PubMed 和 Google scholar 上的最新和历史英文文献:多项动物模型研究比较了胸外按压期间和 ROSC 后不同氧气浓度(大多为 21% 和 100% )的通气情况。这些研究报告称,即使氧气浓度低至 18%,短期结果也没有差异。然而,在心脏骤停和心肺复苏的羔羊模型中,胸外按压时 100% 的氧气浓度与 21% 的氧气浓度相比,能更好地向大脑输送氧气。与 ROSC 后从 100% 氧气缓慢断气相比,ROSC 后迅速断气至 21% 氧气,然后滴定以达到 85-95% 的导联前 SpO2,可最大限度地减少全身高氧和氧化应激:结论:需要开展临床研究,以确定在新生儿心肺复苏期间评估氧合和选择 FiO2 的最佳策略,从而提高存活率和预后。在本文中,我们回顾了新生儿高级心肺复苏期间和 ROSC 后使用氧气的相关证据文献。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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