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Chest compressions superimposed with sustained inflation during neonatal cardiopulmonary resuscitation: are we ready for a clinical trial?
  1. Jenny Koo1,
  2. Po-Yin Cheung2,
  3. Gerhard Pichler3,
  4. Anne Lee Solevåg4,
  5. Brenda Hiu Yan Law2,
  6. Anup C Katheria5,
  7. Georg M Schmölzer6
  1. 1 Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
  2. 2 Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  3. 3 Pediatrics, Medical University Graz, Graz, Austria
  4. 4 The Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lorenskog, Norway
  5. 5 Neonatology, Sharp Mary Birch, San Diego, California, USA
  6. 6 Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
  1. Correspondence to Dr Georg M Schmölzer, Neonatology, Royal Alexandra Hospital, Edmonton, Canada; georg.schmoelzer{at}


Neonates requiring cardiopulmonary resuscitation (CPR) are at risk of mortality and neurodevelopmental injury. Poor outcomes following the need for chest compressions (CCs) in the delivery room prompt the critical need for improvements in resuscitation strategies. This article explores a technique of CPR which involves CCs with sustained inflation (CC+SI). Unique features of CC+SI include (1) improved tidal volume delivery, (2) passive ventilation during compressions, (3) uninterrupted compressions and (4) improved stability of cerebral blood flow during resuscitation. CC+SI has been shown in animal studies to have improved time to return of spontaneous circulation and reduced mortality without significant increase in markers of inflammation and injury in the lung and brain, compared with standard CPR. The mechanics of CCs, rate of compressions, ventilation strategies and compression-to-ventilation ratios are detailed here. A large randomised controlled trial comparing CC+SI versus the current 3:1 compression-to-ventilation ratio is needed, given the growing evidence of its potential benefits.

  • Neonatology
  • Resuscitation

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  • Contributors Manuscript Concept: JK, GS, GP, PYC, BL, ALS, AK. Manuscript structuring: GS. Manuscript drafting: JK. Manuscript revisions: JK, GS, GP, P-YC, BL, ALS, AK. Figures and artwork: JK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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