Effect of different ventilation strategies on gas exchange and on return of spontaneous circulation in newborn piglets with cardiac arrest.

• Applicants: Professor Dr. Helmut Hummler; Dr. Marc Robin Mendler; Dr. Markus Waitz
• Subject Area: Pediatric and Adolescent Medicine
• Term: from 2013 to 2018
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 241216980

Perinatal asphyxia remains a major cause of death and morbidity in the newborn. Perinatal asphyxia and inadequate aeration of the neonatal lungs resulting in hypoxia are the most common causes of postnatal cardiac arrest. Impaired oxygenation of heart tissue leads to bradycardia and decreased blood flow in important organs, such as brain, kidneys and liver. Adequate ventilation of the lungs during neonatal resuscitation is considered to be crucial to improve oxygenation. Physiological aspects support the approach, that administration of continuous positive endexpiratory pressure (PEEP) is the best way for recruitment of lung volume (FRC). Current neonatalresuscitation guidelines (Perlman et al 2010) recommend a specific time schedule for synchronized administration of ventilation and cardiac compressions whereas there are no recommendations forspecific ventilation devices (ventilation bag vs. T-Piece vs. ventilator). The effect of ventilation strategies using PEEP vs. non-PEEP during synchronized ventilation and cardiac compressions on gas exchange and the return of spontaneous circulation is unknown. Furthermore, there are noexisting data from clinical trials or animal models considering the influence of a ventilation strategy using PEEP with a non-synchronized continuous cardiac compression mode. In this case, cardiac compressions could interfere with ventilation and affect gas exchange. However, the described ventilation modes are still part of routine clinical practice. To assess the effect of established ventilation strategies during neonatal resuscitation on oxygenation (uptake of oxygen) and success of resuscitation we designed a randomized controlled trial with an animal model using newbornpiglets. According to clinical practice, the different ventilation modes will be used within the framework of the currently recommended algorithm for neonatal resuscitation. In addition, continuous measurement of variables of gas exchange and pulmonary mechanics will provide further information regarding the quality of the resuscitation procedure and other important data.Particularly, we are interested to measure cerebral tissue oxygenation as evidence suggests that adequate oxygen supply of the brain during and after resuscitation is necessary to improve neurological outcome.This research project will provide new essential information which may be useful to improve resuscitation of newborn infants.

• DFG Programme: Research Grants
• Participating Institution: University of Miami ; Jackson Memorial Hospital ; Department of Pediatrics ; Division of Neonatology