Objective To investigate if external chest compressions (ECC) increase mask leak, and if human or technical feedback improves mask ventilation during simulated neonatal cardiopulmonary resuscitation (CPR).

Study design In this observational study, 32 participants delivered positive pressure ventilation (PPV) to a modified, leak-free manikin via facemask. Mask leak, tidal volume (V_T), positive end expiratory pressure (PEEP) and respiratory rate (RR) were measured with a respiratory function monitor (RFM). Participants had to perform four studies. In the first study, participants performed PPV alone as baseline. Thereafter, three studies were performed in random order. In the PPV+ECC+manometer group, participants had to observe the manometer while the RFM was covered; in the PPV+ECC+RFM group, the RFM was used while the manometer was covered; and in the PPV+ECC+verbal feedback group, the RFM and manometer were covered while a team leader viewed the RFM and provided verbal feedback to the participants.

Results Median (IQR) mask leak of all studies was 15% (5–47%). Comparing the studies, PPV+ECC+RFM and PPV+ECC+verbal feedback had significantly less mask leak than PPV+ECC+manometer.

Mean (SD) V_T of all studies was 9.5±3.5 mL. Comparing all studies, PPV+ECC+RFM had a significantly higher V_T than PPV and PPV+ECC+manometer. As well, PPV+ECC+verbal feedback had a significantly higher V_T than PPV.

PEEP and RR were within our target, mean (SD) PEEP was 6±2 cmH₂O and RR was 36±13/min.

Conclusions During simulated neonatal CPR, ECCs did not influence mask leak, and a RFM and verbal feedback were helpful methods to reduce mask leak and increase V_T significantly.