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American Academy of Pediatrics
Article

Chest Compressions and Ventilation in Delivery Room Resuscitation

Anne Lee Solevåg, Po-Yin Cheung and Georg M. Schmölzer
NeoReviews September 2014, 15 (9) e396-e402; DOI: https://doi.org/10.1542/neo.15-9-e396
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Anne Lee Solevåg
*Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
†Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
‡Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.
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Po-Yin Cheung
*Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
†Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
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Georg M. Schmölzer
*Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
†Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
§Department of Pediatrics, Medical University Graz, Graz, Austria.
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  • Abbreviations:
    CPR;
    cardiopulmonary resuscitation
    CCs;
    chest compressions
    DBP;
    diastolic blood pressure
    CCaV;
    chest compressions and asynchronous ventilations
    C:V;
    compression-to-ventilation ratio
    ROSC;
    return of spontaneous circulation
  • Abstract

    The purpose of chest compressions (CCs) is to generate blood flow to vital organs in a state in which the myocardium is unable to produce forward blood flow by internal pump mechanisms. In newborn infants requiring CCs in the delivery room, the most frequent cause of myocardial compromise is energy depletion due to hypoxia. Hypoxemia and the accompanying hypercarbia and metabolic acidosis (ie, asphyxia) causes systemic vasodilation, further compromising perfusion pressure. Hence, in neonatal cardiopulmonary resuscitation (CPR), the focus is on both reversing hypoxia and enhancing coronary and systemic perfusion pressure. There are limited clinical data to support a recommendation for how CC and ventilation should be optimized for this purpose in the newborn. However, studies in animal models and manikins suggest that using a compression-to-ventilation ratio (C:V) of 3:1 and delivering compressions during a pause in ventilation results in improved ventilation and reversal of hypoxia. Use of the 3:1 ratio, compared with higher C:V ratios, also results in more effective CC during prolonged CPR. A C:V ratio of 3:1 is perceived as more exhausting to perform than higher ratios, and a high CC rate, which may be beneficial, cannot be achieved with pauses in CCs for the delivery of ventilation. Continuous CCs and asynchronous ventilation have been shown to have improved outcomes in adults and older children after cardiac arrest, and current evidence suggests that it is as good as a 3:1 C:V ratio in neonatal resuscitation. Further studies are needed and should focus on the optimal resuscitative approach in neonatal CPR.

    • Copyright © 2014 by the American Academy of Pediatrics

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    1 Sep 2014
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    Chest Compressions and Ventilation in Delivery Room Resuscitation
    Anne Lee Solevåg, Po-Yin Cheung, Georg M. Schmölzer
    NeoReviews Sep 2014, 15 (9) e396-e402; DOI: 10.1542/neo.15-9-e396

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    Chest Compressions and Ventilation in Delivery Room Resuscitation
    Anne Lee Solevåg, Po-Yin Cheung, Georg M. Schmölzer
    NeoReviews Sep 2014, 15 (9) e396-e402; DOI: 10.1542/neo.15-9-e396
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