The SURV1VE-2 Trial has been funded by CIHR - Thank you!!

Saving Newborn Lives: Rethinking CPR in the Delivery Room

Every year, 2–3 million newborn babies around the world need cardiopulmonary resuscitation (CPR) at birth. Tragically, around 1 million of these infants do not survive. For those who do, the journey can be difficult—over half suffer brain damage such as hypoxic-ischemic encephalopathy and seizures, and nearly three-quarters face moderate to severe long-term disabilities.

These statistics highlight a heartbreaking reality: the CPR techniques we use today 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

Currently, CPR for newborns uses a 3-Compression to 1-Ventilation ratio (3:1 C:V). This recommendation comes from animal studies, not large clinical trials, leaving doctors uncertain whether it truly offers the best chance of survival. The need for strong clinical evidence has been identified as a critical gap in newborn resuscitation research.

Our team is exploring an alternative: Chest Compressions plus Sustained Inflation (CC+SI) — a method that delivers both chest compressions and a continuous breath at the same time. We believe this could restore a newborn’s heartbeat faster, improve oxygen delivery to the brain, and ultimately save more lives.

The Questions We’re Asking

1. Primary Question: In newborns with cardiac arrest in the delivery room, does CC+SI (compared to 3:1 C:V) reduce the risk of death before leaving the hospital?

2. 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?

How the Trial Works

We are running 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.

Because newborn CPR happens suddenly and without time for individual randomization, each hospital will use one technique for a set number of cases before switching to the other. Specifically:

• Hospitals will start with either CC+SI or 3:1 C:V (randomly assigned).

• After 15 eligible infants, the hospital will switch to the other technique.

• Parents will be asked for consent after resuscitation to include their baby’s data.

We will use an “intention-to-treat” analysis to make sure the results are fair and unbiased.

The Numbers Behind the Study

• Sample size: 554 babies (277 in each group).

• Power: 80% chance of detecting a real difference if it exists.

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

• Duration: Each hospital will spend about 18 months on each technique.

The Outcome That Matters Most

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

What This Could Mean for the Future

If CC+SI proves better, this trial could change CPR practice for newborns worldwide. More babies could survive their first minutes of life, with fewer facing the devastating effects of brain injury. It would also mean a reduction in the emotional and financial strain on families and health systems.

In short — this research could rewrite the guidelines for saving newborn lives.

Funding: