Experimental paper| Volume 85, ISSUE 2, P270-275, February 2014

3:1 Compression to ventilation ratio versus continuous chest compression with asynchronous ventilation in a porcine model of neonatal resuscitation



      In contrast to the resuscitation guidelines of children and adults, guidelines on neonatal resuscitation recommend synchronized 90 chest compressions with 30 manual inflations (3:1) per minute in newborn infants. The study aimed to determine if chest compression with asynchronous ventilation improves the recovery of bradycardic asphyxiated newborn piglets compared to 3:1 Compression:Ventilation cardiopulmonary resuscitation (CPR).

      Intervention and measurements

      Term newborn piglets (n = 8/group) were anesthetized, intubated, instrumented and exposed to 45-min normocapnic hypoxia followed by asphyxia. Protocolized resuscitation was initiated when heart rate decreased to 25% of baseline. Piglets were randomized to receive resuscitation with either 3:1 compressions to ventilations (3:1 C:V CPR group) or chest compressions with asynchronous ventilations (CCaV) or sham. Continuous respiratory parameters (Respironics NM3®), cardiac output, mean systemic and pulmonary artery pressures, and regional blood flows were measured.

      Main results

      Piglets in 3:1 C:V CPR and CCaV CPR groups had similar time to return of spontaneous circulation, survival rates, hemodynamic and respiratory parameters during CPR. The systemic and regional hemodynamic recovery in the subsequent 4 h was similar in both groups and significantly lower compared to sham-operated piglets.


      Newborn piglets resuscitated by CCaV had similar return of spontaneous circulation, survival, and hemodynamic recovery compared to those piglets resuscitated by 3:1 Compression:Ventilation ratio.


      CC (chest compressions), CPR (cardiopulmonary resuscitation), ROSC (return of spontaneous circulation), CCaV (continuous chest compression with asynchronous ventilation), C:V (Compression:Ventilation), MAP (mean arterial pressure), PAP (pulmonary artery pressure), CVP (central venous pressure), SMA (superior mesenteric artery), PA (pulmonary artery), VT (tidal volume), ECO2 (exhaled CO2)


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