Sustained Inflation and Chest Compression vs 3:1 C:V Ratio in Asphyxiated Newborns (SUR1VE-2)

University of Alberta

Status: Not yet enrolling

Conditions: Cardiac Arrest

Treatments: Procedure: 3:1 C:V (3:1 Compression:Ventilation ratio); Procedure: CC+SI (Chest compression during sustained inflation)

Study type: Interventional

Funder types: Other

Identifiers

NCT06577818

Pro00145624

Details and patient eligibility

About

Newborn infants who require cardiopulmonary resuscitation at birth receive chest compression using a 3-Compression to 1-Ventilation (3:1 C:V) ratio. However, the optimal chest compression technique during cardiopulmonary resuscitation is uncertain and identified as a critical gap in evidence.

The International Consensus Statement advises to use the 3:1 C:V ratio based on animal studies, and states that there are no clinical trials to support this approach and called for more research. There continues to be uncertainty about the optimal chest compression technique during cardiopulmonary resuscitation.

This trial will compare if in newborn infants with cardiac arrest in the delivery room does providing CC+SI (a new chest compression technique) compared to 3:1 C:V decreases the incidence of all mortality within the initial hospital stay.

This will be a multi-centre international cluster randomized trial.

Enrollment: 554 estimated patients

Sex: All

Ages: Under 40 minutes old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Newborns with gestational age born between 28 to 43 weeks based on best available obstetrical estimate
• Newborns designated to receive full resuscitation, i.e., parental request or pre-determined decision to provide only comfort care at birth
• No known major congenital or chromosomal malformation. All newborns who meet inclusion criteria will be enrolled as the centres agreed to change their local hospital policy during the trial. The inclusion criteria are designed to be pragmatic and provide useful knowledge translation for most of the patient population in the future.

Exclusion criteria

• Newborns born outside of study centers and transported to centers after delivery.

Sex, race, and ethnicity are not part of the exclusion criteria for this trial, and as such it should represent the combined demographics of all centers involved.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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554 participants in 2 patient groups

CC+SI (Chest compression during sustained inflation)

Experimental group

Description:

CC+SI Group (Intervention group): Newborns randomized to "CC+SI" will receive CPR with a SI using a peak inflation pressure (PIP) of 30cmH2O while receiving CC. The PIP was chosen based on our animal studies and two previous clinical trials. CC will be performed at a rate of minimum 90/min. Each SI will be delivered for duration of 30sec with a 1 sec pause between the next SI for 30sec is started while CCs are continued. After 2x30sec CC+SI (total of 60sec), Heart rate (HR) will be assessed: A HR \<60/min means CC+SI is continued for another 60sec (2x30sec CC+SI), followed by another HR assessment. If HR \>60/min, CC are stopped (current standard of care). CC+SI will continued until ROSC.

Treatment:

Procedure: CC+SI (Chest compression during sustained inflation)

3:1 C:V (3:1 Compression:Ventilation ratio)

Active Comparator group

Description:

3:1 C:V Group (Control group - Standard of Care): Newborns randomized to "3:1 C:V" will receive a CC rate of 90/min and 30 ventilations/min as per current resuscitation guidelines. The PIP used for the 30 inflations will also be 30cmH2O) as per current resuscitation guidelines. Every 60sec, a HR assessment as per neonatal guidelines will be performed to assess if HR is \<60/min - continue CC or \>60/min - stop CC (current standard of care). 3:1 C:V will be continued until ROSC.

Treatment:

Procedure: 3:1 C:V (3:1 Compression:Ventilation ratio)