Chest compressions superimposed with sustained inflation during neonatal cardiopulmonary resuscitation: are we ready for a clinical trial?
Jenny KooPo-Yin CheungGerhard PichlerAnne Lee SolevågBrenda Hiu Yan LawAnup C KatheriaGeorg Marcus SchmölzerPublished in: Archives of disease in childhood. Fetal and neonatal edition (2024)
Neonates requiring cardiopulmonary resuscitation (CPR) are at risk of mortality and neurodevelopmental injury. Poor outcomes following the need for chest compressions (CCs) in the delivery room prompt the critical need for improvements in resuscitation strategies. This article explores a technique of CPR which involves CCs with sustained inflation (CC+SI). Unique features of CC+SI include (1) improved tidal volume delivery, (2) passive ventilation during compressions, (3) uninterrupted compressions and (4) improved stability of cerebral blood flow during resuscitation. CC+SI has been shown in animal studies to have improved time to return of spontaneous circulation and reduced mortality without significant increase in markers of inflammation and injury in the lung and brain, compared with standard CPR. The mechanics of CCs, rate of compressions, ventilation strategies and compression-to-ventilation ratios are detailed here. A large randomised controlled trial comparing CC+SI versus the current 3:1 compression-to-ventilation ratio is needed, given the growing evidence of its potential benefits.
Keyphrases
- cardiopulmonary resuscitation
- cardiac arrest
- respiratory failure
- room temperature
- clinical trial
- mechanical ventilation
- cerebral blood flow
- study protocol
- cardiovascular events
- oxidative stress
- risk factors
- cardiovascular disease
- white matter
- type diabetes
- randomized controlled trial
- extracorporeal membrane oxygenation
- intensive care unit
- resting state
- coronary artery disease
- acute respiratory distress syndrome
- multiple sclerosis
- double blind
- ionic liquid
- open label
- functional connectivity
- brain injury
- septic shock