Chest compression during sustained inflation versus 3:1 compression-to-ventilation ratio during neonatal cardiopulmonary resuscitation of asphyxiated piglets
- georgschmoelzer
- Nov 13, 2025
- 2 min read
When a baby is born without enough oxygen, every second counts. Doctors and nurses jump into action, performing newborn CPR — chest compressions and small breaths — to try to restart the baby’s heart and breathing.
Right now, international guidelines recommend a 3:1 compression-to-breath ratio, meaning caregivers give three quick chest compressions followed by one breath. But some researchers are exploring whether there’s a better way.
💡 A New Idea: Continuous Compressions with a Gentle Breath Hold
Instead of stopping compressions for each breath, a newer technique keeps the compressions going while maintaining a gentle, steady breath — called a “sustained inflation.”This method (known as CC + SI) might help push air deeper into the lungs while keeping blood flowing to the heart and brain.
🐷 What the Study Did
To test this, scientists studied 132 newborn piglets, who are often used in neonatal research because their hearts and lungs respond similarly to human babies. The piglets were carefully placed under controlled conditions that mimicked birth asphyxia — a serious lack of oxygen leading to cardiac arrest.
Each piglet was resuscitated using one of two methods:
Traditional 3:1 compression-to-breath ratio
Continuous compressions with sustained inflation (CC + SI)
⏱️ What They Found
Both groups had about the same success rate in restarting the heart — around 70–80%.But piglets who received the CC + SI method recovered faster — their hearts started beating again about 74 seconds sooner on average.
After resuscitation, the short-term survival rate (up to 4 hours) was similar between both methods.
❤️ Why This Matters
In neonatal emergencies, even a few seconds can make a difference. A faster return of spontaneous circulation (ROSC) means oxygen and nutrients can reach the brain and other organs sooner, which may protect against long-term damage.
While this study used a piglet model, the results are promising — suggesting that continuous compressions with sustained inflation could help babies in distress get their hearts beating again more quickly. More human studies will be needed before this method becomes part of standard care.
👶 Moving Forward
The SURV1VE-2 trial has been funded by CIHR and wiull start in 2026
We respectfully disagree with the comment. The newborn piglet model is a well-established translational model for neonatal cardiopulmonary resuscitation and key aspects of perinatal cardiopulmonary physiology, and it has consistently provided mechanistic insights that align with human neonatal resuscitation.
More importantly, our clinical evidence supports the physiological rationale observed in the model. In the available delivery-room randomized trials, the findings are consistent and are summarized in our systematic review and meta-analysis: while the pooled estimate did not demonstrate a statistically significant difference in in-hospital mortality (RR 0.64, 95% CI 0.21–1.7), the direction of effect favored CC+SI, and the analysis suggests the potential for fewer deaths per 1,000 infants, albeit with wide uncertainty. Critically, CC+SI was associated with a significant reduction…
After seeing the results of their animal study, which makes it very difficult to compare the causes of bradycardia and cardiac arrest in a human newborn versus an animal like piglets, I continue to insist that they are looking for the wrong answers because their hypothesis does not improve animal survival compared to current standard resuscitation. We must favor studies with clinical applications, such as resuscitation with the umbilical cord intact. If we consider this as a method that reduces the need for intubation and bradycardia, it would be a more preventative method because in infants requiring compressions, something happened during their care that did not improve oxygenation of the heart, adrenal glands, and central nervous system, so the baby…
La realidad es que en la reanimacion neonatal cada segundo cuenta pero muchos estudios buscan respuestas con preguntas equivocadas, ya hay una estrategia que por fisiologia y logica es una maniobra que evita que el recien nacido prematuro o de termino presenta un deteriro de la funcion cardiaca al nacer al iniciar la reanimacion en el sitio de nacimiento aun con el apoyo de la placenta que mientras siga pegada un 50%a su lecho placentario y se pueda percibir el pulso en el cordon umbilical esta manteniendo vivo al recien nacido con apoyo de volumen que permite un flujo minimo adecuado a los organos vitales del recien nacido hablo de miocardio, corteza motora del SNC y adrenales, que una vez…