Chest compression synchronized ventilation versus chest compression superimposed by sustained inflation in
Raza Hyderi1, Shrieya Praveen1, Megan O'Reilly1,2
1Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB, T5H 3V9, Canada.
Background:
Guidelines on neonatal resuscitation recommend 90 chest compressions (CCs) and 30 ventilations (3:1 C:V) per minute in newborns. We have described an alternative resuscitation strategy where CCs are superimposed with sustained inflation (CC + SI), which allows for passive ventilation during compression. A more recent strategy is CCs with synchronized ventilation (CCSV), in which a ventilator flow sensor recognizes airflow during the downward phase of compression and thereby triggers an inflation. No study has compared CCSV with CC + SI in an asphyxiated newborn piglet model. Newborn piglets (n = 8/group) were anesthetized, intubated, instrumented, and exposed to 45 min of normocapnic hypoxia, followed by asphyxia and asystolic cardiac arrest. Piglets were randomized to CCSV or CC + SI. Hemodynamic and respiratory parameters were continuously measured.
Results:
Sixteen neonatal mixed-breed piglets (1-3 days of age, weighing 1.7-2.8 kg) were randomized to CCSV or CC + SI. Median (IQR) time to ROSC was 68 (50-125) s with CCSV and 71 (60-178) s with CC + SI (p = 0.537). The rate of ROSC with CCSV compared to CC + SI was 6/8 (75%) vs. 5/8 (63%), respectively, p = 1.000. CCSV had significantly higher peak inflation pressure (45 vs. 36 cmH2O) and lower positive end-expiratory pressure (5.3 vs. 37 cmH2O) compared to CC + SI (both p < 0.001); tidal volumes were not significantly different.
Conclusions:
Use of CCSV did not result in a faster time to ROSC compared to CC + SI, and survival rates and physiological stability did not differ significantly.
