Neonatal resuscitation with the 15 chest compressions to 2 ventilations pediatric ratio. Would it be comparable to the 3:1 standard?

INTRODUCTION

Neonatal asphyxia is a major cause of neonatal mortality and morbidity worldwide. Most births in resource-limited settings are not attended by a specialist, so the implementation of a universal (for all children) cardiopulmonary resuscitation technique could be efficient. The aim of this study was to compare the quality of neonatal CPR using compression-to-ventilation ratios of 15:2 versus 3:1.

METHODS

A randomized crossover study was conducted with 36 trained nursing students. Neonatal CPR simulations were performed using manikins. Each participant completed four 2-minute CPR simulations, alternating between ventilation and chest compressions using the 15:2 and 3:1 ratios. Rest periods were included to avoid fatigue. Compression and ventilation variables were measured using the Resusci Baby QCPR manikin and SimPad PLUS. We also documented participant preferences.

RESULTS

We found a higher percentage of compressions with adequate depth with the 15:2 CPR ratio (26% vs 11%, P = .005). In terms of ventilations, the 3:1 CPR ratio achieved a higher mean tidal volume (27 vs 24 mL, P = .002) a higher mean ventilation rate per minute (32 vs 15, P < .001) and a higher mean minute volume (809 mL/min vs 351 mL/min, P < .001). The proportion of ventilations with an adequate tidal volume was higher for the 15:2 CPR ratio (74% vs 64%, P = .14), although this difference was not statistically significant.

CONCLUSIONS

In a neonatal CPR simulation model, the 15:2 compression-to-ventilation ratio achieved quality parameters comparable to the 3:1 ratio in terms of performance. The implementation of a unified compression:ventilation ratio (15:2) for CPR from birth through childhood could simplify training and improve the effectiveness of neonatal resuscitation, particularly in settings with limited resources for birth care training. Our results, obtained in a simulated environment, support the performance of studies in real patients.