# Chest compression during sustained inflation versus 3:1 compression-to-ventilation ratio during neonatal cardiopulmonary resuscitation of asphyxiated piglets

## TL;DR

This study compares two neonatal resuscitation techniques in piglets and finds that one method leads to faster return of spontaneous circulation without affecting survival.

## Contribution

The study introduces a new CPR technique (CC + SI) that may improve resuscitation speed in neonates.

## Key findings

- CC + SI led to significantly faster return of spontaneous circulation compared to the 3:1C:V technique.
- There was no significant difference in survival up to 4 hours between the two techniques.
- The benefit of CC + SI was consistent across different oxygen levels but depended on the rate of compressions.

## Abstract

Current neonatal resuscitation guidelines recommend using the 3:1 chest compression-to-ventilation (C:V) ratio technique. However, an alternative technique using continuous compressions superimposed with a high distending pressure or sustained inflation (CC + SI) may improve return of spontaneous circulation (ROSC), survival, and post-resuscitation outcomes.

In a piglet model of asphyxia-induced cardiac arrest, compare time to ROSC with CC + SI or 3:1C:V technique for providing neonatal cardiopulmonary resuscitation (CPR).

Secondary analysis of 132 term newborn mixed breed piglets (1–3 days of age, weighing 1.7–2.4 kg) from six different studies, which were exposed to 30–50 min of normocapnic hypoxia followed by asphyxia until cardiac arrest. This was followed by CPR with either the CC + SI or 3:1C:V technique.

Although the proportion of piglets achieving ROSC was similar between CC + SI and 3:1C:V [59/83 (71 %) vs. 40/49 (82 %)], the time to ROSC was significantly shorter with CC + SI [median (IQR), 87.5 (66.8–147.5) vs. 120 (76.5–267) s; p = 0.0097], corresponding to a mean difference of –73.9 s (95 % CI –122.5 to –25.3). Survival up to 4 h did not differ between groups (risk ratios 1.04, 95 % Confidence intervals 0.82–1.32), with mean (SD) survival time among ROSC survivors of 237 (18) min for CC + SI vs 220 (55) min for 3:1C:V (p = 0.0623). In adjusted analyses, CC + SI yielded faster time to ROSC (Geometric Mean Ratio 0.67, 95 % CI 0.50–0.88), with no effect modification by FiO2, but a rate-dependent effect on time to ROSC; 4-h survival did not differ between methods.

Use of the CC + SI technique during neonatal piglet resuscitation leads to a faster ROSC, with no difference in survival.