@article {Schm{\"o}lzerfetalneonatal-2021-322881, author = {Georg M Schm{\"o}lzer and Calum T Roberts and Douglas A Blank and Shiraz Badurdeen and Suzanne L Miller and Kelly J Crossley and Vanesa Stojanovska and Robert Galinsky and Martin Kluckow and Andrew W Gill and Stuart B Hooper and Graeme R Polglase}, title = {Single versus continuous sustained inflations during chest compressions and physiological-based cord clamping in asystolic lambs}, elocation-id = {fetalneonatal-2021-322881}, year = {2021}, doi = {10.1136/archdischild-2021-322881}, publisher = {BMJ Publishing Group}, abstract = {Background The feasibility and benefits of continuous sustained inflations (SIs) during chest compressions (CCs) during delayed cord clamping (physiological-based cord clamping; PBCC) are not known. We aimed to determine whether continuous SIs during CCs would reduce the time to return of spontaneous circulation (ROSC) and improve post-asphyxial blood pressures and flows in asystolic newborn lambs.Methods Fetal sheep were surgically instrumented immediately prior to delivery at ~139 days{\textquoteright} gestation and asphyxia induced until lambs reached asystole. Lambs were randomised to either immediate cord clamping (ICC) or PBCC. Lambs then received a single SI (SIsing; 30 s at 30 cmH2O) followed by intermittent positive pressure ventilation, or continuous SIs (SIcont: 30 s duration with 1 s break). We thus examined 4 groups: ICC +SIsing, ICC +SIcont, PBCC +SIsing, and PBCC +SIcont. Chest compressions and epinephrine administration followed international guidelines. PBCC lambs underwent cord clamping 10 min after ROSC. Physiological and oxygenation variables were measured throughout.Results The time taken to achieve ROSC was not different between groups (mean (SD) 4.3{\textpm}2.9 min). Mean and diastolic blood pressure was higher during chest compressions in PBCC lambs compared with ICC lambs, but no effect of SIs was observed. SIcont significantly reduced pulmonary blood flow, diastolic blood pressure and oxygenation after ROSC compared with SIsing.Conclusion We found no significant benefit of SIcont over SIsing during CPR on the time to ROSC or on post-ROSC haemodynamics, but did demonstrate the feasibility of continuous SIs during advanced CPR on an intact umbilical cord. Longer-term studies are recommended before this technique is used routinely in clinical practice.Data are available on reasonable request.}, issn = {1359-2998}, URL = {https://fn.bmj.com/content/early/2021/11/28/archdischild-2021-322881}, eprint = {https://fn.bmj.com/content/early/2021/11/28/archdischild-2021-322881.full.pdf}, journal = {Archives of Disease in Childhood - Fetal and Neonatal Edition} }