title: A review of approaches to optimise chest compressions in the resuscitation of asphyxiated newborns.
abstract: OBJECTIVE
  Provision of chest compressions (CCs) and/or medications in the delivery room is associated with poor outcomes. Based on the physiology of perinatal asphyxia, we aimed to provide an overview of current recommendations and explore potential determinants of effective neonatal cardiopulmonary resuscitation (CPR): balancing ventilations and CC, CC rate, depth, full chest recoil, CC technique and adrenaline.
  
  
  METHODS
  A search in the databases MEDLINE (Ovid) and EMBASE until 10 April 2015.
  
  
  METHODS
  Delivery room.
  
  
  METHODS
  Asphyxiated newborn infants.
  
  
  METHODS
  CCs.
  
  
  METHODS
  Haemodynamics, recovery and survival.
  
  
  RESULTS
  Current evidence is derived from mathematical models, manikin and animal studies, and small case series. No randomised clinical trials examining neonatal CC have been performed. There is no evidence to refute a CC to ventilation (C:V) ratio of 3:1. Raising the intrathoracic pressure, for example, by superimposing a sustained inflation on uninterrupted CC, and a CC rate >120/min may be beneficial. The optimal neonatal CC depth is unknown, but factors influencing depth and consistency include the C:V ratio. Incomplete chest wall recoil can cause less negative intrathoracic pressure between CC and reduced CPR effectiveness. CC should be performed with the two-thumb method over the lower third of the sternum. The optimal dose, route and timing of adrenaline administration remain to be determined.
  
  
  CONCLUSIONS
  Successful CPR requires the delivery of high-quality CC, encompassing optimal (A) C:V ratio (B) rate, (C) depth, (D) chest recoil between CC, (E) technique and (F) adrenaline dosage. More animal studies with high translational value and randomised clinical trials are needed.
authors.affiliation: Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Canada Department of Pediatrics, University of Alberta, Edmonton, Canada Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Anne Lee
authors.initials: AL
authors.lastname: Solevåg
authors.affiliation: Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Canada Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Po-Yin
authors.initials: PY
authors.lastname: Cheung
authors.affiliation: Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Canada Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Megan
authors.initials: M
authors.lastname: O'Reilly
authors.affiliation: Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Canada Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Georg M
authors.initials: GM
authors.lastname: Schmölzer
mesh_terms: D000818:Animals; D001238:Asphyxia Neonatorum / Q000628:therapy*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003696:Delivery Rooms; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine / Q000008:administration & dosage; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine
keywords: Neonatology; Resuscitation