Schmölzer GM, Pichler G, Solevåg AL, Law BHY, Mitra S, Wagner M, Pfurtscheller D, Yaskina M, Cheung PY.
Sustained inflation and chest comp
ression
versus 3:
1 chest compression to
ventilation ratio during cardiopulmonary resuscitation of asphyxiated n
ewborns (SURV1VE): A cluster randomised controlled trial.
Arch Dis Child Fetal Neonatal Ed 2024;
109:428-435. [PMID:
38212104 PMCID:
PMC11228189 DOI:
10.1136/archdischild-2023-326383]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/09/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE
In newborn infants requiring chest compression (CC) in the delivery room (DR) does continuous CC superimposed by a sustained inflation (CC+SI) compared with a 3:1 compression:ventilation (3:1 C:V) ratio decreases time to return of spontaneous circulation (ROSC).
DESIGN
International, multicenter, prospective, cluster cross-over randomised trial.
SETTING
DR in four hospitals in Canada and Austria, PARTICIPANTS: Newborn infants >28 weeks' gestation who required CC.
INTERVENTIONS
Hospitals were randomised to CC+SI or 3:1 C:V then crossed over to the other intervention.
MAIN OUTCOME MEASURE
The primary outcome was time to ROSC, defined as the duration of CC until an increase in heart rate >60/min determined by auscultation of the heart, which was maintained for 60 s. Sample size of 218 infants (109/group) was sufficient to detect a clinically important 33% reduction (282 vs 420 s of CC) in time to ROSC. Analysis was intention-to-treat.
RESULTS
Patient recruitment occurred between 19 October 2017 and 22 September 2022 and randomised 27 infants (CC+SI (n=12), 3:1 C:V (n=15), two (one per group) declined consent). All 11 infants in the CC+SI group and 12/14 infants in the 3:1 C:V group achieved ROSC in the DR. The median (IQR) time to ROSC was 90 (60-270) s and 615 (174-780) s (p=0.0502 (log rank), p=0.16 (cox proportional hazards regression)) with CC+SI and 3:1 C:V, respectively. Mortality was 2/11 (18.2%) with CC+SI versus 8/14 (57.1%) with 3:1 C:V (p=0.10 (Fisher's exact test), OR (95% CI) 0.17; (0.03 to 1.07)). The trial was stopped due to issues with ethics approval and securing trial insurance as well as funding reasons.
CONCLUSION
The time to ROSC and mortality was not statistical different between CC+SI and 3:1 C:V.
TRIAL REGISTRATION
NCT02858583.
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