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Return of spontaneous circulation with a compression:ventilation ratio of 15:2 versus 3:1 in newborn pigs with cardiac arrest due to asphyxia
  1. Anne L Solevåg1,2,3,4,
  2. Ingrid Dannevig1,2,3,4,
  3. Myra Wyckoff5,
  4. Ola D Saugstad3,
  5. Britt Nakstad1,2
  1. 1Department of Paediatrics, Akershus University Hospital, Lørenskog, Norway
  2. 2Institute for Clinical Medicine, University of Oslo, Oslo, Norway
  3. 3Department of Paediatric Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  4. 4Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  5. 5Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
  1. Correspondence to Anne L Solevåg, Department of Paediatrics, Akershus University Hospital, 1478 Lørenskog and Department of Paediatric Research, Oslo University Hospital, Rikshospitalet, 0027 Oslo, Norway; a.l.solevag{at}medisin.uio.no

Abstract

Objective International guidelines recommend a compression to ventilation (C:V) ratio of 3:1 in neonates, and 15:2 for other paediatric age groups. The authors aimed to compare these two C:V ratios in a neonatal swine model of cardiac arrest following asphyxia.

Design Experimental animal study.

Setting Facility for animal research.

Subjects 22 newborn pigs (age 12–36 h, weight 2.0–2.7 kg).

Interventions Progressive asphyxia until asystole. Animals were randomised to receive C:V 3:1 (n=11) or 15:2 (n=11).

Main outcome measures Return of spontaneous circulation (ROSC) was defined as a heart rate ≥100 bpm. Also of interest were haemodynamic parameters, cerebral and systemic oxygen saturation and the proinflammatory cytokine interleukin-1β (IL-1β).

Results Two animals in each group did not achieve ROSC. Mean (SD) increase in diastolic blood pressure (DBP; mm Hg) during compression cycles was significantly higher at a C:V ratio of 15:2 than 3:1 (7.1 (2.8) vs 4.8 (2.6)). Median time (IQR) to ROSC for the 3:1 group was 150 (140–180) s, and 195 (145–358) s for the 15:2 group. There were no significant differences in the temporal changes in haemodynamic parameters or oxygen saturation indices between the groups. IL-1β levels in cerebrospinal and bronchoalveolar lavage fluid was comparable between the groups.

Conclusion In neonatal pigs with asphyxia-induced cardiac arrest, the response to a C:V ratio of 15:2 is not better than the response to a C:V ratio of 3:1 despite better generation of DBP during resuscitation.

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Footnotes

  • Funding The authors thank the Laerdal Foundation for Acute Medicine and the University of Oslo's Foundation at Akershus University Hospital for significant financial contributions to the study.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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