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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. 1 Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Alberta Health Services, Edmonoton, Canada
  2. 2 Division 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}


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 NCT02083705, pre-results.

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

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  • 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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