Background: Recently, sustained inflations (SI) during chest compression (CC) (CC+SI) have been suggested as an alternative to the current approach during neonatal resuscitation. No previous study compared CC+SI using CC rates of 90/min to the current 3:1 compression:ventilation ratio (C:V). Objective: To determine whether CC+SI versus a 3:1 C:V reduces the time to the return of spontaneous circulation (ROSC) and improves hemodynamic recovery in newborn piglets with asphyxia-induced bradycardia. Intervention and Measurements: Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-min normocapnic hypoxia followed by asphyxia. Cardiopulmonary resuscitation (CPR) was initiated when the heart rate decreased to 25% of baseline. Piglets were randomized into 3 groups: CC during SI at a rate of 90 CC/min (SI+CC 90, n = 8), a 3:1 C:V using 90 CC and 30 inflations (3:1, n = 8), or a sham group (n = 6). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. Results: CC+SI significantly reduced the median (IQR) time of ROSC, i.e., 34 s (28-156 s) versus 210 s (72-300 s) in the 3:1 group (p = 0.048). CC+SI also significantly reduced the requirement for 100% oxygen, improved respiratory parameters, and resulted in a similar hemodynamic recovery. Conclusions: CC+SI during CPR significantly improved ROSC in a porcine model of neonatal resuscitation. This is of considerable clinical relevance because improved respiratory and hemodynamic parameters potentially minimize morbidity and mortality in newborn infants.

Perlman JM, Wyllie JP, Kattwinkel J, Wyckoff MH, Aziz K, Guinsburg R, et al: Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation 2015;132:S204-S241.
Aziz K, Chadwick M, Baker M, Andrews W: Ante- and intra-partum factors that predict increased need for neonatal resuscitation. Resuscitation 2008;79:444-452.
Wyckoff MH: Chest compressions for bradycardia or asystole in neonates. Clin Perinatol 2012;39:833-842.
Wyckoff MH, Perlman JM: Cardiopulmonary resuscitation in very low birth weight infants. Pediatrics 2000;106:618-620.
Shah PS: Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a systematic review and meta-analyses. J Perinatol 2009;29:655-661.
Finer N, Tarin T, Vaucher YE, Barrington KJ, Bejar R: Intact survival in extremely low birth weight infants after delivery room resuscitation. Pediatrics 1999;104:e40.
DeMauro SB, Roberts RS, Davis PG, Alvaro R, Bairam A, Schmidt B, et al: Impact of delivery room resuscitation on outcomes up to 18 months in very low birth weight infants. J Pediatr 2011;159:546-550.e1.
Harrington DJ, Redman CW, Moulden M, Greenwood CE: The long-term outcome in surviving infants with Apgar zero at 10 min: a systematic review of the literature and hospital-based cohort. Am J Obstet Gynecol 2007;196:463.e1-463.e5.
Schmölzer GM, O'Reilly M, LaBossiere J, Lee T-F, Cowan S, Qin S, et al: Cardiopulmonary resuscitation with chest compressions during sustained inflations: a new technique of neonatal resuscitation that improves recovery and survival in a neonatal porcine model. Circulation 2013;128:2495-2503.
Babbs C, Meyer A, Nadkarni V: Neonatal CPR: room at the top - a mathematical study of optimal chest compression frequency versus body size. Resuscitation 2009;80:1280-1284.
Solevåg AL, Cheung P-Y, Lie H, O'Reilly M, Aziz K, Nakstad B, et al: Chest compressions in newborn animal models: a review. Resuscitation 2015;96:151-155.
Kilkenny C, Altman DG, Browne WJ, Cuthill IC, Emerson M: Improving bioscience research reporting: the ARRIVE guidelines for reporting animal research. PLoS Biol 2010;8:e1000412.
Wyckoff MH, Berg RA: Optimizing chest compressions during delivery-room resuscitation. Semin Fetal Neonatal Med 2008;13:410-415.
Chandra N, Weisfeldt ML, Tsitlik J, Vaghaiwalla F, Snyder LD, Hoffecker M, et al: Augmentation of carotid flow during cardiopulmonary resuscitation by ventilation at high airway pressure simultaneous with chest compression. Am J Cardiol 1981;48:1053-1063.
Chandra N, Rudikoff M, Weisfeldt M: Simultaneous chest compression and ventilation at high airway pressure during cardiopulmonary resuscitation. Lancet 1980;315:175-178.
Sobotka K, Hooper SB, Allison BJ, Te Pas AB, Davis PG, Morley CJ, et al: An initial sustained inflation improves the respiratory and cardiovascular transition at birth in preterm lambs. Pediatr Res 2011;70:56-60.
Li ES-S, Cheung P-Y, Lee T-F, Lu M, O'Reilly M, Schmölzer GM: Return of spontaneous circulation is not affected by different chest compression rates superimposed with sustained inflations during cardiopulmonary resuscitation in newborn piglets. PLoS One 2016;11:e0157249-14.
Solevåg AL, Cheung P-Y, Li ES-S, Aziz K, O'Reilly M, Fu B, et al: Quantifying force application to a newborn manikin during simulated cardiopulmonary resuscitation. J Matern Fetal Neonatal Med 2016;29:1770-1772.
Li ES-S, Cheung P-Y, O'Reilly M, Aziz K, Schmölzer GM: Rescuer fatigue during simulated neonatal cardiopulmonary resuscitation. J Perinatol 2015;35:142-145.
Solevåg AL, Schmölzer GM, O'Reilly M, Lu M, Lee T-F, Hornberger LK, et al: Myocardial perfusion and oxidative stress after 21 versus 100% oxygen ventilation and uninterrupted chest compressions in severely asphyxiated piglets. Resuscitation 2016;106:7-13.
Linner R, Werner O, Perez-de-Sa V, Cunha-Goncalves D: Circulatory recovery is as fast with air ventilation as with 100% oxygen after asphyxia-induced cardiac arrest in piglets. Pediatr Res 2009;66:391-394.
Saugstad OD, Ramji S, Soll R, Vento M: Resuscitation of newborn infants with 21 or 100% oxygen: an updated systematic review and meta-analysis. Neonatology 2008;94:176-182.
Sobotka K, Hooper SB, Crossley KJ, Ong T, Schmölzer GM, Barton SK, et al: Single sustained inflation followed by ventilation leads to rapid cardiorespiratory recovery but causes cerebral vascular leakage in asphyxiated near-term lambs. PLoS One 2016;11:e0146574-1.
Hillman NH, Kemp MW, Noble PB, Kallapur SG, Jobe AH: Sustained inflation at birth did not protect preterm fetal sheep from lung injury. Am J Physiol Lung Cell Mol Physiol 2013;305:L446-L453.
Harling AE, Beresford MW, Vince GS, Bates M, Yoxall CW: Does sustained lung inflation at resuscitation reduce lung injury in the preterm infant? Arch Dis Child Fetal Neonatal 2005;90:F406-F410.
Li ES-S, Cheung P-Y, O'Reilly M, Schmölzer GM: Change in tidal volume during cardiopulmonary resuscitation in newborn piglets. Arch Dis Child Fetal Neonatal Ed 2015;100: F530-F533.
Li ES-S, Cheung P-Y, Pichler G, Aziz K, Schmölzer GM: Respiratory function and near infrared spectroscopy recording during cardiopulmonary resuscitation in an extremely preterm newborn. Neonatology 2014;105:200-204.
Chalak LF, Barber CA, Hynan L, Garcia D, Christie L, Wyckoff MH: End-tidal CO2 detection of an audible heart rate during neonatal cardiopulmonary resuscitation after asystole in asphyxiated piglets. Pediatr Res 2011;69:401-405.
Solevåg AL, Dannevig I, Wyckoff MH, Saugstad OD, Nakstad B: Extended series of cardiac compressions during CPR in a swine model of perinatal asphyxia. Resuscitation 2010;81:1571-1576.
Solevåg AL, Dannevig I, Wyckoff MH, Saugstad OD, Nakstad B: Return of spontaneous circulation with a compression:ventilation ratio of 15:2 versus 3:1 in newborn pigs with cardiac arrest due to asphyxia. Arch Dis Child Fetal Neonatal Ed 2011;96:F417-F421.
Mendler MR, Weber C, Hassan MA, Huang L, Waitz M, Mayer B, et al: Effect of different respiratory modes on return of spontaneous circulation in a newborn piglet model of hypoxic cardiac arrest. Neonatology 2015;109:22-30.
Mendler MR, Weber C, Hassan MA, Huang L, Mayer B, Hummler HD: Tidal volume delivery and endotracheal tube leak during cardiopulmonary resuscitation in intubated newborn piglets with hypoxic cardiac arrest exposed to different modes of ventilatory support. Neonatology 2016;111:100-106.
Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J, et al: Part 15: Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S909-S919.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.