Optimal Inspired Oxygen Weaning Strategy Following Return of Spontaneous Circulation After Perinatal Asphyxial Arrest

Background: Early hyperoxemia in neonates with perinatal acidemia is associated with higher incidence of hypoxic-ischemic encephalopathy (Kapadia et al J Peds 2013). Hence, judicious use of oxygen (O2) during resuscitation is warranted. In neonatal cardiac arrest at term gestation, current NRP guidelines recommend initiation of positive pressure ventilation (PPV) with 21% O2 and titration based on SpO2, but 100% O2 during chest compressions (CC). However, following return of spontaneous circulation (ROSC), a combination of hyperemia (due to hypercarbia) and hyperoxia can result in cerebral oxidative stress and reperfusion injury. Objective: Abrupt weaning of inspired O2 to 21% after ROSC followed by upward titration (21%O2-titrate up) will limit hyperoxia without altering cerebral oxygen delivery (C-DO2) compared to gradual weaning from 100% O2 with …