Cardiopulmonary Resuscitation with Chest Compressions during Sustained Inflations: A New Technique of Neonatal Resuscitation that Improves Recovery and Survival in a Neonatal Porcine Model
Background—Guidelines on neonatal resuscitation recommend 90 chest compressions (CC) and 30 manual inflations (3:1) per minute in newborns. The study aimed to determine if CC s during sustained inflations (SI) improves recovery 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. Piglets were randomized to receive either 3:1 resuscitation (3:1-group), or CCs during SIs (SI-group) when heart rate decreased to 25% of baseline. Piglets randomized to SI-group received SIs with a pressure of 30 cmH2O for 30sec. During the SI, CCs at a rate of 120/min were provided. SI was interrupted after 30sec for one second before a further 30sec SI was provided. CCs were continued throughout SIs. CC and SI were continued until return of spontaneous circulation (ROSC). Continuous respiratory parameters, cardiac output, mean systemic and pulmonary artery pressures, and regional blood flows were measured. Mean (SD) time for ROSC was significantly reduced in SI-group vs. 3:1-group [32(11)sec vs. 205(113)sec, respectively]. In the SI-group, administration of oxygen and epinephrine was significantly lower, whilst minute ventilation and exhaled CO2 were significantly increased. 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 carotid blood flow.
Conclusions—Combining CCs and SIs significantly improved ROSC with better hemodynamic recovery in asphyxiated newborn piglets when compared to standard coordinated 3:1 resuscitation.
- Received February 27, 2013.
- Revision received August 6, 2013.
- Accepted August 30, 2013.