Chest compression superimposed with sustained inflation - translating preclinical findings into a neonatal clinical trial.

Neonatal cardiopulmonary resuscitation (CPR) remains associated with high mortality and significant risk of neurodevelopmental impairment. Current neonatal resuscitation guidelines recommend a 3:1 compression-to-ventilation (C:V) ratio, which inherently requires frequent interruptions in chest compressions, limits ventilation efficiency, and may delay return of spontaneous circulation (ROSC). To address these limitations, we have examined chest compressions with sustained inflation (CC + SI) as an alternative approach. Preliminary data from animal studies and pilot human trials suggest (1) improved tidal volume delivery, (2) facilitation of passive ventilation during compressions, (3) uninterrupted chest compressions, and (4) more stable cerebral blood flow during resuscitation. Experimental studies in asphyxiated animal models have demonstrated that CC + SI improves oxygenation, shortens time to ROSC, and reduces mortality without increasing pulmonary or cerebral injury when compared with standard 3:1 CPR. Two small pilot trials in human neonates support the feasibility of CC + SI. However, larger randomized controlled trials are required to validate these findings and determine whether CC + SI can safely and effectively replace the current 3:1 C:V approach as the standard of care in neonatal resuscitation.