Chest compression synchronized ventilation versus chest compression superimposed by sustained inflation in asphyxiated newborn piglets: a randomized animal trial.

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.