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‘Keeping the beat’: What is the best way to perform neonatal chest compressions?

In 2022, Ramachandran S, Bruckner M, Wyckoff M, and myself worked on an International Liaison Committee on Resuscitation Scoping review to review the currently available evidence about chest compressions.

The title of the scoping review was: Chest compressions in newborn infants: a scoping review

Recently, ADC FN published an editorial by Jonathan Cusack about our scoping review: ‘Keeping the beat’: What is the best way to perform neonatal chest compressions? - the link is here: Thank you!

What did we do and what did we find?

The abstract is below:

As you can read, there are many manikin and animal studies, but there is alack of human data, which highlights the difficulties of performing studies where chest compressions are performed.

Aim The International Liaison Committee on Resuscitation Neonatal Life Support Task Force undertook a scoping review of the literature to identify evidence relating to neonatal cardiopulmonary resuscitation.

Methods MEDLINE complete, EMBASE and Cochrane database of Systematic reviews were searched from inception to November 2021. Two authors screened titles and abstracts and full text reviewed.

Studies were eligible for inclusion if they were peer-reviewed and assessed one of five aspects of chest compression in the newborn infant including:

(1) heart rate thresholds to start chest compressions (CC),

(2) compression to ventilation ratio (C:V ratio),

(3) CC technique,

(4) oxygen use during CC and

(5) feedback devices to optimise CC.

Results Seventy-four studies were included (n=46 simulation, n=24 animal and n=4 clinical studies); 22/74 were related to compression to ventilation ratios, 29/74 examined optimal technique to perform CC, 7/74 examined oxygen delivery and 15/74 described feedback devices during neonatal CC.

Conclusion There were very few clinical studies and mostly manikin and animal studies. The findings either reinforced or were insufficient to change previous recommendations which included to start CC if heart rate remains <60/min despite adequate ventilation, using a 3:1 C:V ratio, the two-thumb encircling technique and 100% oxygen during CC.

As Jonathan Cusack pointed out: "This scoping review highlights the challenges of producing evidence-based recommendations when there are so few high-quality neonatal resuscitation trials. There is a pressing need to continue to fund and promote research into neonatal resuscitation practice and to continue to use the ILCOR processes to review and update guidelines as new evidence becomes available".

We couldn't agree more, and we hope that there will be future trials in neonatal cardiopulmonary resuscitation.

CSAR is trying to lead the way by have published a pilot trial in neonatal CPR:

- and the SURV1VE-2 trial, which is currently in the planning phase - if you are interested in doing this trial - please email us at


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