3:1 Compression to ventilation ratio versus continuous chest compression with asynchronous ventilation in a porcine model of neonatal resuscitation

Schmölzer, Georg M.; O’Reilly, Megan; LaBossière, Joseph; Lee, Tze-Fun; Cowan, Shaun; Nicoll, Jessica; Bigam, David L.; Cheung, Po-Yin

doi:10.1016/j.resuscitation.2013.10.011

Cited by 73 publications

(82 citation statements)

References 17 publications

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“…2). Alternatively, studies using continuous CC with asynchronized ventilation reported similar times to ROSC when compared to 3: 1 C:V (114 vs. 143 s, respectively) [21]. These studies suggest that during neonatal CPR, different C:V ratios do not improve outcomes and might not be the optimal CC approach in newborn infants.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, an argument for synchronized CPR is the potential interference of nonsynchronized CC with V T delivery, and hence the impairment of oxygen delivery. However, previous studies reported that only 25% of manual inflations are impeded by CC [21]. Also, a recent study by Li et al [29] reported that during 3: 1 C:V, lung derecruitment can occur, which potentially causes lung collapse, and hence increased lung inflammation.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Different Compression to Ventilation Ratios (2: 1, 3: 1, and 4: 1) during Cardiopulmonary Resuscitation in a Porcine Model of Neonatal Asphyxia

et al. 2018

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Background: High-quality chest compression is essential during neonatal cardiopulmonary resuscitation (CPR). However, the optimal compression to ventilation ratio (C:V) that should be used during neonatal CPR to optimize coronary and cerebral perfusion while providing adequate ventilation remains unknown. Objective: We hypothesized that different C:V ratios (e.g., 2: 1 or 4: 1) will reduce the time to return of spontaneous circulation (ROSC) in severely asphyxiated piglets. Methods: Thirty-one newborn piglets (1–4 days old) were anesthetized, intubated, instrumented, and exposed to 50-min normocapnic hypoxia followed by asphyxia. Piglets were randomized into 4 groups: 2: 1 (n = 8), 3: 1 (n = 8), 4: 1 (n = 8) C:V ratio, or a sham group (n = 7). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. Results: Thirty-one piglets were included in the study, and there was no difference in the duration of asphyxia or the degree of asphyxiation (as indicated by pH, PaCO₂, and lactate) among the different groups. The median (IQR) time to ROSC was similar between the groups with 127 (82–210), 96 (88–126), and 119 (83–256) s in the 2: 1, 3: 1, and 4: 1 C:V ratio groups, respectively (p = 0.67 between groups). Similarly, there was no difference in 100% oxygen requirement or epinephrine administration between the experimental groups. Conclusions: Different C:V ratios resulted in similar ROSC, mortality, oxygen, and epinephrine administration during resuscitation in a porcine model of neonatal asphyxia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Different Compression to Ventilation Ratios (2: 1, 3: 1, and 4: 1) during Cardiopulmonary Resuscitation in a Porcine Model of Neonatal Asphyxia

et al. 2018

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“…In addition, the three-minute CC depth decline was 50% if CCs were performed at the rate of 120 × min -1 vs. 30% if they were performed at the rate of 90 × min -1 . Schmölzer et al [25] indicated that newborn piglets resuscitated by continuous CCs had a similar return of spontaneous circulation, survival, and haemodynamic recovery compared with piglets resuscitated with 3:1 C:V ratio. In contrast, Zhan et al [26] found that bystander-administered, CC-only CPR supported by telephone instruction increased the proportion of people who survived to hospital discharge as compared to conventional interrupted CC CPR plus rescue breathing.…”

Section: Discussionmentioning

confidence: 99%

Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial

et al. 2018

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A b s t r a c tBackground: Early bystander cardiopulmonary resuscitation (CPR) for cardiac arrest is crucial in the chain of survival. Cardiac arrest in infants is rare, but CPR is also performed in severe bradycardia. European Resuscitation Council and American Heart Association guidelines recommend continuing CPR until the heart muscle is sufficiently oxygenated and regains sufficient contractility and function. The most common and recommended CPR techniques that can be applied in newborns are the two-finger technique and two-thumb technique. Aim:We sought to assess the quality of CPR performed in newborns with the two-finger technique depending on the position of the rescuer during resuscitation. Methods:This was a prospective, randomised, crossover, simulated study. It involved 93 nurses who were required to perform a two-minute CPR using the two-finger technique in three scenarios: (A) with the newborn lying on the floor; (B) on a table; and (C) with the newborn on the rescuer's forearm. The Newborn Tory ® S2210 manikin was used to simulate a neonatal patient in cardiac arrest. The following parameters were measured: chest compression (CC) depth, CC rate, no-flow time, percentage of full release, ventilation rate, and ventilation volume, as well as the number of effective compressions and effective ventilations.Results: Statistical analysis showed significant differences in CC rates between scenarios A and B (p < 0.001) and between scenarios B and C (p = 0.002). Significant differences were also observed between the median CC depth. The median percentage of no-flow-fraction was the highest for scenario A (55%), followed by scenario B (48%), and scenario C (46%). There were significant differences between the values of no-flow-fraction between scenarios A and B (p < 0.001), and between scenarios A and C (p < 0.001). The percentage of chest full releases for scenarios A, B, and C amounted to 94%, 1%, and 92%, respectively. Significant differences in the number of effective CCs between scenarios A and B (p < 0.001) as well as B and C (p < 0.001) were revealed. The median ventilation rate was highest for scenario B (13 × min ). The highest tidal volume was obtained in scenario A (27 mL), and the lowest in scenario C (26 mL). The most effective CPR was performed when resuscitation was carried out on the rescuer's forearm. Conclusions:The quality of CCs in newborns depends on the location of the patient and the rescuer. The optimal form of resuscitation of newborns is resuscitation on the rescuer's forearm.

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“…On the other hand, Dorph et al [21] found no difference in coronary perfusion pressure using a higher compression:ventilation ratio of 30:2 or with compressions only in a piglet model. Schmölzer et al [4] showed no differences regarding time to ROSC comparing 90 continuous compressions per minute with asynchronous breathing and the conventional 3:1 ratio. In our group with the continuous compression mode, we used the additional ‘time slot' to increase compressions per minute (up to 120/min), so as to optimize circulatory support as suggested for resuscitation of children and adults [22].…”

Section: Discussionmentioning

confidence: 99%

“…The implementation of this synchronized sequence is also influenced by the method of respiratory support. There are no studies to show that the interposition of the inflation in a pause between CC is necessary or beneficial as compared to nonsynchronous continued CC with a rate of 120/min [4,5]. …”

Section: Introductionmentioning

confidence: 99%

Different Techniques of Respiratory Support Do Not Significantly Affect Gas Exchange during Cardiopulmonary Resuscitation in a Newborn Piglet Model

Mendler¹,

Maurer²,

Hassan

et al. 2015

Neonatology

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Background: There are no evidence-based recommendations on the use of different techniques of respiratory support and chest compressions (CC) during neonatal cardiopulmonary resuscitation (CPR). Objectives: We studied the short-term effects of different ventilatory support strategies along with CC representing clinical practice on gas exchange [arterial oxygen saturation (SaO₂), arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂)], hemodynamics and cerebral oxygenation. We hypothesized that in newborn piglets with cardiac arrest, use of a T-piece resuscitator (TPR) providing positive end-expiratory pressure (PEEP) improves gas exchange as measured by SaO₂ during CPR as compared to using a self-inflating bag (SIB) without PEEP. Furthermore, we explored the effects of a mechanical ventilator without synchrony to CC. Methods: Thirty newborn piglets with asystole were randomized into three groups and resuscitated for 20 min [fraction of inspired oxygen (FiO₂) = 0.21 for 10 min and 1.0 thereafter]. Group 1 received ventilation using a TPR [peak inspiratory pressure (PIP)/PEEP of 20/5 cm H₂O, rate 30/min] with inflations interposed between CC (3:1 ratio). Group 2 received ventilation using a SIB (PIP of 20 cm H₂O without PEEP, rate 30/min) with inflations interposed between CC (3:1 ratio). Group 3 received ventilation using a mechanical ventilator (PIP/PEEP of 20/5 cm H₂O, rate 30/min). CC were applied with a rate of 120/min without synchrony to inflations. Results: We found no significant differences in SaO₂ between the three groups. However, there was a trend toward a higher SaO₂ [TPR: 28.0% (22.3-40.0); SIB: 23.7% (13.4-52.3); ventilator: 44.1% (39.2-54.3); median (interquartile range)] and a lower PaCO₂ [TPR: 95.6 mm Hg (82.1-113.6); SIB: 100.8 mm Hg (83.0-108.0); ventilator: 74.1 mm Hg (68.5-83.1); median (interquartile range)] in the mechanical ventilator group. Conclusions: We found no significant effect on gas exchange using different respiratory support strategies during CPR.

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3:1 Compression to ventilation ratio versus continuous chest compression with asynchronous ventilation in a porcine model of neonatal resuscitation

Cited by 73 publications

References 17 publications

Comparison of Different Compression to Ventilation Ratios (2: 1, 3: 1, and 4: 1) during Cardiopulmonary Resuscitation in a Porcine Model of Neonatal Asphyxia

Comparison of Different Compression to Ventilation Ratios (2: 1, 3: 1, and 4: 1) during Cardiopulmonary Resuscitation in a Porcine Model of Neonatal Asphyxia

Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial

Different Techniques of Respiratory Support Do Not Significantly Affect Gas Exchange during Cardiopulmonary Resuscitation in a Newborn Piglet Model

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