RESEARCH ARTICLE


Lung Injury in Asphyxiated Newborn Pigs Resuscitated from Cardiac Arrest - The Impact of Supplementary Oxygen, Longer Ventilation Intervals and Chest Compressions at Different Compression-to-Ventilation Ratios



Ingrid Dannevig*, 1, 2, 3, 4, Anne L Solevåg1, 2, 3, 4, Ola D Saugstad3, Britt Nakstad1, 2
1 Dept. of Paediatrics, Akershus University Hospital, N-1478 Lørenskog, Norway
2 Institute of Clinical Medicine, University of Oslo, N-1478 Lørenskog, Norway
3 Dept. of Paediatric Research, Oslo University Hospital, Rikshospitalet, P.O Box 4950 Nydalen, N-0424 Oslo, Norway
4 Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, P.O Box 4950 Nydalen, 0424 Oslo, Norway


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© Dannevig et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Paediatrics, Akershus University Hospital, 1478 Lørenskog, Norway; Tel: +47 02900; Fax: +4767961170; E-mail: ingrid.dannevig@medisin.uio.no


Abstract

Introduction:

Non-specific lung inflammatory events caused by severe asphyxia may be intensified by the way we resuscitate the newly born. Assessing lung injury is potentially important because if alternative resuscitation approaches induces similar inflammatory responses or less lung injury. then we may choose the resuscitation approach that is most gentle, and easiest to perform and learn. We investigated the levels of lung inflammatory markers by comparing different ventilation, chest compression and inhaled oxygen fraction strategies in resuscitation of newly born pigs at cardiac arrest.

Materials and Methodology:

Progressive asphyxia in newborn pigs was induced until asystole occurred. With current resuscitation guidelines as a reference group, pigs were randomized to receive initial ventilation before chest compressions for 30s, 60s or 90s, or to compression-to-ventilation ratios 3:1or 9:3, or to resuscitation using pure oxygen or air. We analysed inflammatory markers in bronchoalveolar lavage fluid (BAL), IL8 and TNFα, and lung tissue qPCR for genes matrix metalloproteinases (MMP)2, MMP9, TNFα and ICAM-1.

Results:

BAL-levels of TNFα and IL8 tended to be higher in the 30s group compared to 60s group (p = 0.028 and p = 0.023, respectively) as was gene expression in lung tissue of ICAM-1 and MMP2 (p=0.012 and p=0.043, respectively). MMP2 expression was slightly higher in the 30s group compared to 90s group (p = 0.020). No differences were found between pigs resuscitated with C:V ratio 9:3 and 3:1 or pure oxygen versus air.

Conclusion:

Compared to current guidelines, with respect to lung injury, resuscitation with longer initial ventilation should be considered. Longer series of chest compressions did not change the lung inflammatory response, neither did the use of air instead of pure oxygen in severely asphyxiated pigs resuscitated from asystole.

Keywords:: Newborn, asphyxia, lung inflammation, room air, resuscitation, BAL, MMP2, MMP9, TNFα, IL8, ICAM-1..