Comparison of mask leak and respiratory mechanics in synchronized versus decoupled chest compression in a newborn manikin model

Abstract Purpose: Newborn mask ventilation technique requires skills, and effective resuscitation is essential for pulmonary gas exchange. The most effective compression to ventilation (C:V) ratio in newborn resuscitation is still contentious and there is no evidence of human data supporting the current 3:1 ratio. We aimed to study mask leak and respiratory mechanics comparing synchronized and decoupled chest compression on a newborn manikin model.Methods: Twenty-eight neonatal staff members trained in newborn resuscitation were randomly paired to provide mask ventilation with chest compression in a synchronized (3:1) C:V ratio followed by decoupled chest compression (CC) at a rate of 120 compression to 60 inflations per minute. A Laerdal Advanced Life Support leak-free manikin and a 240-mL self-inflating bag were used. Respiratory mechanical data were collected and analysed.Results: Decoupled CC provided significantly higher minute ventilation (825.3 mL/min) compared to 534.8 mL/min with the synchronized CC group (p<0.0001). The mean mask leak (%) was 27.9 (CI 18.4 – 37.4) in the synchronized CC group and 25.3 (CI 17.6 – 33.1) in the decoupled CC group. Higher mean airway pressure was noted in the decoupled CC group. Conclusion: Mask leak was unchanged with introduction of decoupled CC to a traditional 3:1 C:V ratio. However, decoupled CC provided significantly higher minute ventilation. Human studies to investigate the respiratory mechanics and hemodynamic effects of decoupled CC are needed.