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Assessment of optimal chest compression depth during neonatal cardiopulmonary resuscitation: a randomised controlled animal trial
  1. Marlies Bruckner1,2,3,
  2. Seung Yeon Kim2,3,4,
  3. Gyu Hong Shim2,3,5,
  4. Mattias Neset2,6,
  5. Catalina Garcia-Hidalgo2,7,
  6. Tze-Fun Lee2,3,
  7. Megan O'Reilly2,3,
  8. Po-Yin Cheung2,3,
  9. Georg M Schmölzer2,3
  1. 1 Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
  2. 2 Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, University of Alberta, Edmonton, Alberta, Canada
  3. 3 Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  4. 4 Department of Pediatrics, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
  5. 5 Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, South Korea
  6. 6 Engineering, University of Alberta, Edmonton, Alberta, Canada
  7. 7 Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr Georg M Schmölzer, Department of Pediatrics, Royal Alexandra Hospital, Edmonton, Canada; georg.schmoelzer{at}me.com

Abstract

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.

  • neonatology
  • resuscitation

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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