Abstract 15536: Chest Compressions During Sustained Inflations: A Novel Technique of Neonatal Resuscitation That Improves Recovery and Survival in a Neonatal Porcine Model

Abstract

Background: Guidelines on neonatal resuscitation recommend 90 chest compressions (CC) and 30 manual inflations (3:1) per minute in newborn infants. However, the optimal compressions to inflations ratio remains unknown.

Objective: The study aimed to determine if CCs during sustained inflations (SI) improves return of spontaneous circulation (ROSC) of asphyxiated newborn piglets compared to coordinated 3:1 resuscitation.

Methods and Results: Term newborn piglets (n=8/group) were anesthetized, intubated, instrumented and exposed to 45-minute normocapnic hypoxia followed by asphyxia. Protocolized resuscitation was initiated when heart rate decreased to 25% of baseline. Piglets were randomized to receive either 3:1 resuscitation (3:1 group) according to the current resuscitation guidelines, or CCs during SIs (SI group). Piglets randomized to the SI group received a SI with a peak inflating pressure of 30 cm H2O for 30 sec. During the SI, CCs were provided at a rate of 120 per minute. SI was interrupted after 30 sec for one second before a further 30 sec SI was provided. During the whole time CCs were continued. CC and SIs were continued until ROSC. Continuous respiratory parameters (Respironics NM3®), cardiac output, mean systemic and pulmonary artery pressures, and regional blood flows were measured.

Results: Median (IQR) time for ROSC was significantly reduced in the SI group vs. 3:1 group [38 (23-44) sec vs. 143 (84-303) sec, respectively, p=0.0008]. In the SI group, administration of oxygen and epinephrine was significantly lower, whilst minute ventilation and exhaled CO2 were significantly increased, compared to the 3:1 group. The SI group had significantly higher mean systemic and pulmonary arterial pressures during resuscitation compared to the 3:1 group [51(10) vs. 31(5) mmHg; 41(7) vs. 31(7) mmHg, respectively; all p<0.05], with improved cardiac output and common carotid blood flow. Both SI and 3:1 groups had similar mesenteric and renal blood flows during recovery.

Conclusions: Combining CCs and SI significantly improved ROSC with better hemodynamic recovery in asphyxiated newborn piglets when compared to the standard coordinated 3:1 resuscitation.