Abstract
Current recommendation for chest compressions in neonatal resuscitation is to use a coordinated 3:1 ratio of chest compressions to ventilations (C:V), interrupting every third compression to deliver an assisted ventilation. Despite this recommendation, the evidence is still unclear on the optimal C:V ratio for use in neonates. Our team has previously reported a novel technique of sustained inflations with chest compressions (SI+CC) reduces time to return of spontaneous circulation and improves hemodynamic recovery. The objective of this study was to determine differences in hypoxic injury and oxidative stress markers of heart and lung in piglets resuscitated with SI+CC compared to a coordinated 3:1 C:V. We found that the SI+CC technique reduces oxidative stress in lung tissues and cumulative oxygen exposure with no differences in hypoxic injury. Our findings lend further support to transitioning this technique to neonatal resuscitation practice.
Highlights
Most newborn infants successfully transition from fetal to neonatal life [1]
We recently demonstrated that superimposing chest compressions (CC) with sustained inflation (CC+SI) compared to 3:1 C:V in a piglet model of neonatal asphyxia significantly improve return of spontaneous circulation (ROSC), mortality, as well as hemodynamic and respiratory parameters [10,11]
A total of 3/8 in the 3:1 C:V group versus 7/8 in the CC+SI group (p=0.0192), and 4/4 of the sham-operated piglets survived to 4-hour recovery
Summary
Most newborn infants successfully transition from fetal to neonatal life [1]. Approximately 10% of near-term and term deliveries will require some form of respiratory support during fetal to neonatal transition, whereas infrequently some newborns (~0.08%) will require aggressive interventions such as chest compressions (CC) or epinephrine administration [1,2,3]. The guidelines recommend using a coordinated Compression: Ventilation (C:V) ratio of 3:1 if CC are needed. This approach is composed of 90 CC and 30 inflations per minute, with a pause after every 3rd CC to deliver one effective ventilation. The most effective C:V ratio in newborns remains undetermined
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