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Chest compression during sustained inflation versus 3:1 chest compression:ventilation ratio during neonatal cardiopulmonary resuscitation: a randomised feasibility trial
  1. Georg M Schmölzer1,2,
  2. Megan O Reilly1,2,
  3. Caroline Fray1,
  4. Sylvia van Os1,
  5. Po-Yin Cheung1,2
  1. 1Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Alberta Health Services, Edmonoton, Canada
  2. 2Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada
  1. Correspondence to Dr Georg M Schmölzer, Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; georg.schmoelzer{at}me.com

Abstract

Background Current neonatal resuscitation guidelines recommend 3:1 compression:ventilation (C:V) ratio. Recently, animal studies reported that continuous chest compressions (CC) during a sustained inflation (SI) significantly improved return of spontaneous circulation (ROSC). The approach of CC during SI (CC+SI) has not been examined in the delivery room during neonatal resuscitation.

Hypothesis It is a feasibility study to compare CC+SI versus 3:1 C:V ratio during neonatal resuscitation in the delivery room. We hypothesised that during neonatal resuscitation, CC+SI will reduce the time to ROSC. Our aim was to examine if CC+SI reduces ROSC compared with 3:1 C:V CPR in preterm infants <33 weeks of gestation.

Study design Randomised feasibility trial.

Method Once CC was indicated all eligible infants were immediately and randomly allocated to either CC+SI group or 3:1 C:V group. A sequentially numbered, brown, sealed envelope contained a folded card box with the treatment allocation was opened by the clinical team at the start of CC.

Study interventions Infants in the CC+SI group received CC at a rate of 90/min during an SI with a duration of 20 s (CC+SI). After 20 s, the SI was interrupted for 1 s and the next SI was started for another 20 s until ROSC. Infants in the ‘3:1 group’ received CC using 3:1 C:V ratio until ROSC.

Primary outcome Overall the mean (SD) time to ROSC was significantly shorter in the CC+SI group with 31 (9) s compared with 138 (72) s in the 3:1 C:V group (p=0.011).

Conclusion CC+SI is feasible in the delivery room.

Trial registration number Clinicaltrials.gov NCT02083705, pre-results.

  • neonatology
  • delivery room
  • chest compression
  • newborn
  • sustained inflation

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Footnotes

  • Contributors GMS, SvO, MOR and P-YC: conception and design. GMS, SvO, CF, MOR and P-YC: collection and assembly of data; analysis and interpretation of the data; drafting of the article; critical revision of the article for important intellectual content; final approval of the article.

  • Funding The public did donation to the following funding agencies: GMS is a recipient of the Heart and Stroke Foundation/University of Alberta Professorship of Neonatal Resuscitation and a Heart and Stroke Foundation Canada and a Heart and Stroke Foundation Alberta New Investigator Award.

  • Competing interests None declared.

  • Ethics approval The Royal Alexandra Hospital Research Committee and Health Ethics Research Board, University of Alberta.

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

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