Arch Dis Child Fetal Neonatal Ed 98:F42-F45 doi:10.1136/archdischild-2011-301334
  • Original articles

The 3:1 is superior to a 15:2 ratio in a newborn manikin model in terms of quality of chest compressions and number of ventilations

  1. Jeffrey Perlman3
  1. 1Division of Newborn Nursing, New York Presbyterian Hospital, New York, New York, USA
  2. 2Department of Pediatrics, New York Presbyterain Hospital, New York, New York, USA
  3. 3Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Jeffrey Perlman, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medical College, 525 E 68th Street, N506, New York, NY 10065, USA; jmp2007{at}
  1. Contributors All the authors were involved in the conception and design, analysis and interpretation of data. They were also involved in the drafting and revisions of the article for important intellectual content and gave final approval of the version to be published. There is no individual who met the above criteria not listed on the manuscript.

  • Received 7 November 2011
  • Accepted 20 February 2012
  • Published Online First 3 April 2012


Background Most cases of delivery room cardiopulmonary arrest result from an asphyxial process. Experimental evidence supports an important role for ventilation during asphyxial arrest. The optimal compression: ventilation (CV) ratio remains unclear and recommendations for newborns have varied from 3:1, 5:1 and 15:2.

Objective Compare 3:1, 5:1 and 15: 2 CV ratios using the two-thumb technique in relationship to depth of compressions, decay of compression depth over time, compression rates and breaths delivered.

Methods Thirty-two subjects, physicians and neonatal nurses, participated with compressions performed on a manikin. Evaluations included 2 min of compressions using 3:1, 5:1 and 15:2 CV ratios.

Results Compression depth was comparable between groups. By paired analysis per subject, the depth was only greater for 3:1 versus 15:2 (ie, 0.91±2.2 mm) (p=0.01) and greater for women than men. Comparing the initial and second minute of compressions, no decay in compression depth for 3:1 ratio was noted, however significant decay was observed for 5:1 and 15:2 ratios (p<0.05). The compression rates were least and ventilations breaths were highest for 3:1 as opposed to the other ratios (p<0.05).

Conclusions Providers using a 3:1 versus 15:2 achieve a greater depth of compressions over 2 min with a greater difference noted in women. More consistent compression depth over time was achieved with 3:1 as opposed to the other ratios. Thus, the 3:1 ratio is appropriate for newly born infants requiring resuscitation.


  • Competing interests None.

  • Funding Funded in part by a grant from the Academy of Pediatrics.

  • Ethics approval Institutional Review Board of Weill Cornell Medical College.

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

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