Lunch & Learn on the Science of Chest Compression in Newborn Babies - the SURV1VE trial

Saving Newborn Lives: Rethinking CPR in the Delivery Room

Every year, an estimated 2–3 million newborn babies around the world need chest compression - what is also called cardiopulmonary resuscitation (CPR) at birth. Tragically, around 1 million do not survive. For those who do, the journey is often difficult: more than half suffer brain injury such as hypoxic-ischemic encephalopathy or seizures, and nearly three-quarters face moderate to severe long-term disabilities.

These statistics highlight a heartbreaking reality: the CPR techniques we currently use for newborns may not be the best we can offer. Could a different approach save more lives and protect more babies from lifelong harm?

Why This Research Matters

The recommended method of newborn CPR today uses a 3 chest compressions to 1 ventilation (3:1 C:V) ratio. This guideline was based primarily on animal studies rather than robust clinical trials. As a result, we simply don’t know if 3:1 is truly the best strategy for newborns.

That knowledge gap is what drives our research team. We are testing an alternative approach: Continuous Chest Compressions with Sustained Inflation (CC+SI).

Instead of interrupting compressions to deliver breaths, CC+SI keeps the lungs open with a continuous breath while compressions are performed. We believe this method could:

• Restore a newborn’s heartbeat faster.

• Improve blood flow and oxygen delivery to the brain.

• Increase survival and reduce the risk of brain injury.

The SURV1VE trial was a pilot trial, which showed feasibility and safety.

The Questions We’re Asking

Our trial is designed to answer critical questions:

• Primary Question: In newborns needing CPR at birth, does CC+SI (compared to 3:1 C:V) reduce the risk of death before hospital discharge?

• Secondary Questions:

  • Does CC+SI shorten the time to return of spontaneous circulation (ROSC)?

  • Does it reduce the risk of severe complications, such as brain injury?

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How the Trial Works

We are conducting the SURV1VE-2 - Trial - a multi-center, cluster randomized crossover trial across hospitals in Canada, USA, Ireland, UK, Austria, Zimbabwe, South Africa, India, Pakistan, Australia, New Zealand, and Chile.

Here’s how it works:

• Each hospital starts with either CC+SI or 3:1 C:V (randomly assigned).

• After treating 15 eligible newborns, the hospital switches to the other technique.

• Because newborn CPR happens suddenly, parents are approached after resuscitation for consent to include their baby’s data.

• Data will be analyzed on an intention-to-treat basis, ensuring fairness and reducing bias.

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The Numbers Behind the Study

• Sample size: 554 babies (277 per group).

• Power: 80% chance of detecting a true difference if one exists.

• Target difference: Reduce mortality from 36% (3:1 C:V) to 24% (CC+SI) — a one-third reduction.

• Timeline: Each hospital will spend ~18 months on each technique.

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What Success Would Mean

Our primary outcome is clear: Did the baby survive to hospital discharge?

If CC+SI proves to be more effective, the impact could be transformative:

• More babies surviving those critical first minutes of life.

• Fewer infants living with devastating brain injuries.

• Less emotional and financial strain on families and health systems.

This trial has the potential to rewrite the global guidelines for newborn CPR and improve the lives of millions of babies and families worldwide.