Evaluating the influence of ventilation and ventilation-compression synchronization on chest compression force and depth during simulated neonatal resuscitation

Abstract

Objectives: To investigate the influence of ventilation and ventilation-compression synchronization on compression force and sternal displacement during simulated neonatal cardiopulmonary resuscitation (NCPR) on an infant manikin.

Methods: Five Neonatal Resuscitation Program trained clinicians were recruited to perform simulated NCPR on an infant manikin using two-finger (TF) and two-thumb (TT) compression, with synchronous and asynchronous ventilation, as well as without ventilation. The sternal displacement and force were recorded and analyzed.

Results: Synchronous ventilation and compression yielded sternal displacements and forces in the range of 22.8–32.4 mm and 15.0–29.8 N, respectively, while asynchronous ventilation and compression produced depths and forces in the range of 21.2–32.4 mm and 14.0–28.8 N, respectively.

Conclusions: Ventilation exerts a significant influence on sternal displacement and force during simulated NCPR, regardless of the compression method used. Ventilation-compression synchronization, however, is only significant during TF compression with lower compression forces measured during synchronous ventilation than in asynchronous ventilation. This occurs for two reasons: (i) the strong influence of ventilation forces on the lower magnitude compression forces produced during TF compression relative to TT compression and (ii) in asynchronous ventilation, compression and ventilation may occur simultaneously, with inflation and deflation providing an opposing force to the applied compression force.

Keywords:

• Chest compression
• neonatal cardiopulmonary resuscitation
• phasing of ventilation and chest compression
• synchronous and asynchronous ventilation

Acknowledgements

The authors are grateful to Kevin Neaves and Adele de Villiers for their help with the manikin tests, and to the clinician volunteers from the Tygerberg Children's Hospital NICU.

Declaration of interest

The authors are unaware of any potential conflict of interest that could influence this study's results.