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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

Abstract

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.

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