Chest compression during sustained inflation versus 3:1 chest compression:ventilation ratio during neonatal cardiopulmonary resuscitation: a randomised feasibility trial

Schmölzer, Georg M.; Reilly, Megan O; Fray, Caroline; Os, Sylvia van; Cheung, Po–Yin

doi:10.1136/archdischild-2017-313037

Cited by 45 publications

(56 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A similar observation was reported during chest recoil after the application of a downward force on the chest of infants undergoing surgery requiring general anesthesia [29]. Additionally, the first randomized controlled trial comparing CC+SI and 3:1 C:V in preterm infants <33 weeks' gestation during neonatal resuscitation in the delivery room used a distending pressure of 24 cmH 2 O reported adequate V T delivery [30]. All of the aforementioned studies suggest the optimal PIP for CC+SI is approximately 20-25 cmH 2 O.…”

Section: Discussionsupporting

confidence: 66%

“…Although there were more piglets that achieved ROSC following resuscitation with CC+SI_PIP_20, this was not significantly different compared to using CC+SI_PIP_10 and CC+SI_PIP_30. During CC+SI, improved carotid blood flow, mean arterial pressure, % change in ejection fraction, cardiac output, alveolar oxygen delivery and lung aeration may all result in faster ROSC by increasing intrathoracic pressure and improving minute ventilation [18][19][20][21]30]. In our study there were significant differences in minute ventilation between groups, but there were no differences in carotid blood flow at 1 hour after ROSC.…”

Section: Discussionmentioning

confidence: 42%

“…In our study, the use of 30 [42]. The CC+SI_PIP_30 group had the lowest exhaled CO 2 , which was below the 14 mmHg cut-off.…”

Section: Discussionmentioning

confidence: 48%

See 2 more Smart Citations

Effects of sustained inflation pressure during neonatal cardiopulmonary resuscitation of asphyxiated piglets

Shim

Kim

Cheung

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

ObjectiveSustained inflation (SI) during chest compression (CC = CC+SI) significantly reduces time to return of spontaneous circulation (ROSC) compared to 3:1 compression-to-ventilation ratio during neonatal resuscitation. However, the optimal peak inflation pressure (PIP) of SI during CC+SI to improve ROSC and hemodynamic recovery in severely asphyxiated piglets is unknown.AimTo examine if different PIPs of SI during CC+SI will improve ROSC and hemodynamic recovery in severely asphyxiated piglets.Intervention and measurementsTwenty-nine newborn piglets (1-3 days old) were anesthetized, intubated, instrumented and exposed to 30-min normocapnic hypoxia followed by asphyxia. Piglets were randomized into four groups: CC+SI with a PIP of 10 cmH2O (CC+SI_PIP_10, n=8), a PIP of 20 cmH2O (CC+SI_PIP_20, n=8), a PIP of 30 cmH2O (CC+SI_PIP_30, n=8), and a sham-operated control group (n=5). Heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment.Main resultsBaseline parameters were similar between all groups. There was no difference in asphyxiation (duration and degree) between intervention groups. PIP correlated positively with tidal volume and inversely with exhaled CO2 during cardiopulmonary resuscitation. Time to ROSC and rate of ROSC were similar between piglets resuscitated with CC+SI_PIP_10, CC+SI_PIP_20, and CC+SI_PIP_30 cmH2O: median (IQR) 75 (63-193) sec, 94 (78-210) sec, and 85 (70-90) sec; 5/8 (63%), 7/8 (88%), and 3/8 (38%) (p=0.56 and p=0.12, respectively). All piglets that achieved ROSC survived to four hours post-resuscitation. Piglets resuscitated with CC+SI_PIP_30 cmH2O exhibited increased concentrations of pro-inflammatory cytokines interleukin-1β and tumour necrosis factor-α in the frontoparietal cerebral cortex (both p<0.05 vs. sham-operated controls).ConclusionsIn asphyxiated term newborn piglets resuscitated by CC+SI, the use of different PIPs resulted in similar time to ROSC, but PIP at 30 cmH2O showed a larger VT delivery, lower exhaled CO2 and increased tissue inflammatory markers in the brain.

show abstract

Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 42%

See 1 more Smart Citation

Effects of sustained inflation pressure during neonatal cardiopulmonary resuscitation of asphyxiated piglets

Shim

Kim

Cheung

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…While this first study used a CC rate of 120/min (in the CC + SI group) instead of the recommended 90/min, further studies using CC rates of 90/min in the same animal model have confirmed the initial findings [87][88][89][90]. Also a recent pilot trial in preterm infants <32 weeks' gestation showed similar results to the animal studies with a reduction in the mean (SD) time to ROSC with 31 (9) sec vs. 138 (72) sec in the CC + SI group and 3:1 C:V group (p = 0.011), respectively [91]. These data suggest that CC + SI has the potential to improve neonatal CPR, and a large randomized trial is currently ongoing to compare CC + SI with 3:1 C:V. Until these data are available, the 3:1 C:V ratio should be used during neonatal CPR.…”

Section: Chest Compressionssupporting

confidence: 71%

Resuscitation of Term Infants in the Delivery Room

Viaroli¹,

Schmölzer²

2018

Special Topics in Resuscitation

View full text Add to dashboard Cite

The majority of newborn infants make the transition from fetal-to-neonatal live without help. However, around 20% of newborn infants fail to initiate breathing at birth. In these cases, the clinical team has to provide respiratory support, which remains the cornerstone of neonatal resuscitation. This chapter will discuss respiratory support during neonatal resuscitation in both term and preterm infants. The chapter will discuss the respiratory fetal-to-neonatal transition, use of oxygen, mask ventilation and their pitfalls, the application of sustained inflation, positive end expiratory pressure, continuous positive airway pressures, and whether extremely low birth weight infants should be intubated immediately after birth or supported noninvasively.

show abstract

“…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. In comparison with the recommended 3: 1 C:V, combining CC with sustained inflation has been shown to be more effective in improving ROSC in piglets [15, 22-24], but not in lambs [25]. …”

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Chest compression during sustained inflation versus 3:1 chest compression:ventilation ratio during neonatal cardiopulmonary resuscitation: a randomised feasibility trial

Abstract: Clinicaltrials.gov NCT02083705, pre-results.

Cited by 45 publications

References 29 publications

Effects of sustained inflation pressure during neonatal cardiopulmonary resuscitation of asphyxiated piglets

Effects of sustained inflation pressure during neonatal cardiopulmonary resuscitation of asphyxiated piglets

Resuscitation of Term Infants in the Delivery Room

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

Contact Info

Product

Resources

About