![]() ![]() There is a lack of scientific evidence to support this standard of care in neonatal CPR, and the unique physiology of perinatal transition as well as cerebral and cardiovascular immaturity call for special considerations in DR CPR. CCs should be delivered at a rate of 90/min synchronized with ventilations at a rate of 30/min to achieve a total of 120 events/min ( 7). However, because cardiovascular collapse in the DR is almost invariably due to hypoxia, neonatal resuscitation guidelines recommend a 3:1 C:V ratio ( 7). Thus, more uninterrupted CC in a series is generally regarded to be beneficial. In addition, pediatric and adult animal data demonstrate better coronary perfusion pressures (CPP) with less CC interruption ( 3– 6). In animals with ventricular fibrillation (VF) cardiac arrest, adequately oxygenated blood can be circulated with CC for up to 4–6 min even without assisted ventilation ( 2). Ultimately, the physiological effects in the infant determine the most optimal CC intervention. Thus, besides CPR mechanics and mathematical modeling, educational, emotional, and physical aspects of provider performance need to be considered when addressing the optimal CC algorithm. The effectiveness of CC is influenced by (i) CC rate, (ii) CC to ventilation (C:V) ratio, and (iii) applied force, which are all influenced by the CC provider (Figure 1). Thus, optimizing CC quality may improve outcomes both by preserving cerebral blood flow during cardiac arrest and by reducing recovery time. Improved cerebral perfusion ensures brain cell survival during CPR, whereas enhanced myocardial perfusion increases the likelihood of a fast return of spontaneous circulation (ROSC). High quality chest compressions (CC) improve cerebral and myocardial perfusion. Observational data indicate that prolonged cardiopulmonary resuscitation (CPR) in the delivery room (DR) is associated with poor survival and neurologic outcomes ( 1). Different CC rates and ratios should also be investigated under controlled experimental conditions in animals during perinatal transition. Video recording of DR CRP has been increasingly applied and observational studies of what is actually done in relation to outcomes could be useful. Evidence indicates that providers perform CC at rates both higher and lower than recommended. Mechanical/automated CC in neonatal CPR has not been explored, and feedback systems are under-investigated in this population. However, duty cycle cannot be controlled with manual CC. Not only rate but duty cycle, i.e., the duration of CC/total cycle time, is a known determinant of CC effectiveness. In post-transitional piglets with asphyxia-induced cardiac arrest, there was no benefit of performing continuous CC at a rate of 90/min. ![]() ![]() A higher rate (e.g., 120/min) is also more fatiguing, which affects CC quality. Despite mathematical and physiological rationales that higher rates and uninterrupted CC improve CPR hemodynamics, studies indicate that provider fatigue is more pronounced when CC are performed continuously compared to when a pause is inserted after every third CC as currently recommended. Thus, many biomechanical aspects of CC have been investigated in animal and manikin models. Also, the infrequent occurrence of extensive CPR measures in the DR make randomized controlled trials difficult to perform. ![]() Despite a lack of scientific evidence supporting this, the investigation of alternative CC interventions in human neonates is ethically challenging. CCs should be delivered at a rate of 90/min synchronized with ventilations at a rate of 30/min to achieve a total of 120 events/min. Neonatal resuscitation guidelines recommend a 3:1 C:V ratio. Thus, provider performance should be taken into account. CC quality is determined by rate, CC to ventilation (C:V) ratio, and applied force, which are influenced by the CC provider. Thus, optimizing CC quality may improve outcomes both by preserving cerebral blood flow during CPR and by reducing the recovery time. Improved myocardial perfusion increases the likelihood of a faster ROSC. 2Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, CanadaĬardiopulmonary resuscitation (CPR) duration until return of spontaneous circulation (ROSC) influences survival and neurologic outcomes after delivery room (DR) CPR.1The Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway. ![]()
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