Aim The study aimed to examine the optimal anterior-posterior depth which will reduce the time to return of spontaneous circulation and improve survival during chest compressions. Asphyxiated neonatal piglets receiving chest compression resuscitated with a 40% anterior-posterior chest depth compared with 33%, 25% or 12.5% will have reduced time to return of spontaneous circulation and improved survival.
Methods Newborn piglets (n=8 per group) were anaesthetised, intubated, instrumented and exposed to 45 min normocapnic hypoxia followed by asphyxia and cardiac arrest. Piglets were randomly allocated to four intervention groups (‘anterior-posterior 12.5% depth’, ‘anterior-posterior 25% depth’, ‘anterior-posterior 33% depth’ or ‘anterior-posterior 40% depth’). Chest compressions were performed using an automated chest compression machine with a rate of 90 per minute. Haemodynamic and respiratory parameters, applied compression force, and chest compression depth were continuously measured.
Results The median (IQR) time to return of spontaneous circulation was 600 (600–600) s, 135 (90–589) s, 85 (71–158)* s and 116 (63–173)* s for the 12.5%, 25%, 33% and 40% depth groups, respectively (*p<0.001 vs 12.5%). The number of piglets that achieved return of spontaneous circulation was 0 (0%), 6 (75%), 7 (88%) and 7 (88%) in the 12.5%, 25%, 33% and 40% anterior-posterior depth groups, respectively. Arterial blood pressure, central venous pressure, carotid blood flow, applied compression force, tidal volume and minute ventilation increased with greater anterior-posterior chest depth during chest compression.
Conclusions Time to return of spontaneous circulation and survival were similar between 25%, 33% and 40% anterior-posterior depths, while 12.5% anterior-posterior depth did not result in return of spontaneous circulation or survival. Haemodynamic and respiratory parameters improved with increasing anterior-posterior depth, suggesting improved organ perfusion and oxygen delivery with 33%–40% anterior-posterior depth.
Trial registration number PTCE0000193.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Contributors Conception and design: GMS, P-YC, MOR, T-FL. Collection and assembly of data: GMS, P-YC, MOR, T-FL, MB, SYK, GHS, MN, CG-H. Analysis and interpretation of data: GMS, P-YC, MOR, T-FL, MB, SYK, GHS, MN, CG-H. Drafting of the article: GMS, P-YC, MOR, T-FL, MB, SYK, GHS, MN, CG-H. Critical revision of the article for important intellectual content: GMS, P-YC, MOR, T-FL, MB, SYK, GHS, MN, CG-H. Final approval of the article: GMS, P-YC, MOR, T-FL, MB, SYK, GHS, MN, CG-H.
Funding GMS is a recipient of the Heart and Stroke Foundation/University of Alberta Professorship of Neonatal Resuscitation, a National New Investigator of the Heart and Stroke Foundation of Canada, and an Alberta New Investigator of the Heart and Stroke Foundation of Alberta.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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