• Anne Lee Solevåg, Po-Yin Cheung, Megan O'Reilly, and Georg M Schmölzer.
• 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.
• Arch. Dis. Child. Fetal Neonatal Ed. 2016 May 1; 101 (3): F272-6.

ObjectiveProvision 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.DesignA search in the databases MEDLINE (Ovid) and EMBASE until 10 April 2015.SettingDelivery room.PatientsAsphyxiated newborn infants.InterventionsCCs.Main Outcome MeasuresHaemodynamics, recovery and survival.ResultsCurrent 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.ConclusionsSuccessful 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.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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