Jennifer Lutz, DO
Fellow
Alfred I DuPont Hospital for Children
Wilmington, Delaware
Disclosure information not submitted.
Yosef Levenbrown, DO
Pediatric Intensivist
Alfred I DuPont Hospital for Children, United States
Disclosure information not submitted.
Kelly Massa, RRT
Registered Respiratory Therapist
Nemours/A.I. duPont Hospital for Children, United States
Disclosure information not submitted.
Anne Hesek
Supervisor of Research Surgical Services
Nemours/A.I. duPont Hospital for Children, United States
Disclosure information not submitted.
Thomas Shaffer, MSE, PhD
Director of Nemours Research Lung Center
Nemours / AI DuPont Hospital for Children, United States
Disclosure information not submitted.
Title: Impact of Intravenous Fluid Administration on Cardiac Output in Cardiopulmonary Resuscitation
INTRODUCTION/HYPOTHESIS:
Cardiac output during cardiopulmonary resuscitation (CPR) has been shown to be less than 20% of the heart’s native function at best, leading to reduced oxygen delivery to organs. The effect of intravenous fluid (IVF) administration during CPR is an unexplored, modifiable factor that may improve this outcome. The hypothesis of this study is that the administration of IVF will augment cardiac output (CO) during CPR without compromising oxygenation.
Methods:
The porcine model was chosen due to its comparable size to human pediatric patients. The pigs were anesthetized, intubated, and placed on positive pressure ventilation. Following anesthetic induction, internal jugular central venous and carotid arterial catheters were placed. Irreversible cardiac arrest was induced with bupivacaine. CPR was performed with a LUCAS 3 mechanical compression device. Pigs were randomized into an IVF or no IVF group. Pigs in the IVF group were given 20 mL/kg of lactated ringers from minute 15 to minute 35 of the CPR. CPR was maintained for 50 minutes with serial measurements of CO using ultrasound dilution technology (COstatus cardiac output monitor) and paO2.
Results:
Comparisons were made using the Mann Whitney test. CO and paO2 for the seven pigs in the study to date (four in the no IVF group and three in the IVF group) were measured at 10-minute intervals during the 50 minutes of CPR. Mean CO (mL/min) was as follows: In the IVF group, 3.15, 0.72, 0.82, 0.96, 0.96, 0.88. Compared to this, the mean CO in the no IVF group was as follows: 4.37 (p=0.94), 0.74 (p=0.64), 0.85 (p=0.57), 0.74 (p=0.2), 0.58 (p=0.2), 0.72 (p=0.43). Mean paO2 (mmHg) measured at the same intervals was as follows: In the IVF group, 411, 209, 195.33, 176.33, 154.33, 153.67. Compared to this, the mean paO2 in the no IVF group was as follows: 324.5 (p=0.2), 139 (p=0.2), 143.75 (p=0.43), 139 (p=0.43), 131 (p=0.43), 133.75 (p=0.43).
Conclusion:
Compared to not receiving IVF during CPR, administration of IVF did not result in a statistically significant increase in cardiac output at any time point. It also did not have a statistically significant impact on oxygenation.