Evaluation of the Neonatal Resuscitation Program's recommended chest compression depth using computerized tomography...

Area of Science:

• Neonatal resuscitation
• Pediatric cardiology
• Thoracic imaging

Background:

• Neonatal Resuscitation Program (NRP) guidelines recommend 1/3 anterior-posterior (AP) chest depth for neonatal resuscitation.
• The appropriateness of this compression depth has not been rigorously evaluated.

Purpose of the Study:

• To compare the efficacy and safety of neonatal chest compression depths of 1/4, 1/3, and 1/2 AP chest depth during cardiopulmonary resuscitation.

Main Methods:

• Neonatal chest CT scans were used to measure chest dimensions.
• Mathematical modeling estimated ejection fraction (EF) and residual chest depth for 1/4, 1/3, and 1/2 AP compression depths.
• Under-compression and over-compression were defined based on predicted EF and residual chest depth.

Main Results:

• Estimated ejection fraction increased with compression depth (1/4 AP: 51%, 1/3 AP: 69%, 1/2 AP: 106%).
• Under-compression was predicted with 1/4 AP depth (29/54 patients).
• Over-compression was predicted with 1/2 AP depth (49/54 patients).

Conclusions:

• Current NRP recommendations of 1/3 AP chest depth appear more effective than 1/4 AP depth.
• Current NRP recommendations of 1/3 AP chest depth appear safer than 1/2 AP depth.
• Chest CT-based mathematical modeling supports 1/3 AP chest compression depth for neonatal resuscitation.