title: Extended series of cardiac compressions during CPR in a swine model of perinatal asphyxia.
abstract: BACKGROUND
  The rationale for a compression to ventilation ratio of 3:1 in neonates with primary hypoxic, hypercapnic cardiac arrest is to emphasize the importance of ventilation; however, there are no published studies testing this approach against alternative methods. An extended series of cardiac compressions offers the theoretical advantage of improving coronary perfusion pressures and hence, we aimed to explore the impact of compression cycles of two different durations.
  
  
  METHODS
  Newborn swine (n = 32, age 12-36 h, weight 2.0-2.7 kg) were progressively asphyxiated until asystole occurred. Animals were randomized to receive compressions:ventilations 3:1 (n=16) or 9:3 (n=16). Return of spontaneous circulation (ROSC) was defined as a heart rate ≥ 100 beats min⁻¹.
  
  
  RESULTS
  All animals except one in the 9:3 group achieved ROSC. One animal in the 3:1 group suffered bradycardia at baseline, and was excluded, leaving us with 15 animals in each group surviving to completion of protocol. Time to ROSC (median and interquartile range) was 150 s (115-180) vs. 148 s (116-195) for 3:1 and 9:3, respectively (P = 0.74). There were no differences in diastolic blood pressure during compression cycles or in markers of hypoxia and inflammation. The temporal changes in mean arterial blood pressure, heart rate, arterial blood gas parameters, and systemic and regional oxygen saturation were comparable between groups.
  
  
  CONCLUSIONS
  Neonatal pigs with asphyxia-induced cardiac arrest did not respond to a compression:ventilation ratio of 9:3 better than to 3:1. Future research should address if alternative compression:ventilation ratios offer advantages over the current gold standard of 3:1.
authors.affiliation: Department of Paediatric Research, Oslo University Hospital, Rikshospitalet, 0027 Oslo, Norway. a.l.solevag@medisin.uio.no
authors.forename: Anne L
authors.initials: AL
authors.lastname: Solevåg
authors.forename: Ingrid
authors.initials: I
authors.lastname: Dannevig
authors.forename: Myra
authors.initials: M
authors.lastname: Wyckoff
authors.forename: Ola D
authors.initials: OD
authors.lastname: Saugstad
authors.forename: Britt
authors.initials: B
authors.lastname: Nakstad
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D000831:Animals, Newborn; D001237:Asphyxia / Q000628:therapy*; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage / Q000379:methods*; D053583:Interleukin-1beta / Q000032:analysis / Q000134:cerebrospinal fluid; D007773:Lactates / Q000097:blood / Q000134:cerebrospinal fluid; D008991:Monitoring, Physiologic; D019289:Pyruvic Acid / Q000097:blood / Q000134:cerebrospinal fluid; D011897:Random Allocation; D012044:Regression Analysis; D019265:Spectroscopy, Near-Infrared; D018709:Statistics, Nonparametric; D013552:Swine
chemical_list: D053583:Interleukin-1beta; D007773:Lactates; D019289:Pyruvic Acid