PT  - JOURNAL ARTICLE
AU  - Marlies Bruckner
AU  - Seung Yeon Kim
AU  - Gyu Hong Shim
AU  - Mattias Neset
AU  - Catalina Garcia-Hidalgo
AU  - Tze-Fun Lee
AU  - Megan O'Reilly
AU  - Po-Yin Cheung
AU  - Georg M Schmölzer
TI  - Assessment of optimal chest compression depth during neonatal cardiopulmonary resuscitation: a randomised controlled animal trial
AID  - 10.1136/archdischild-2021-321860
DP  - 2022 May 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - 262--268
VI  - 107
IP  - 3
4099  - http://fn.bmj.com/content/107/3/262.short
4100  - http://fn.bmj.com/content/107/3/262.full
SO  - Arch Dis Child Fetal Neonatal Ed2022 May 01; 107
AB  - 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.All data relevant to the study are included in the article or uploaded as supplementary information.