Chest Compression Techniques for Cardiac Arrest in Newborns
(SUR1VE-2 Trial)

Recruiting in Palo Alto (17 mi)

Overseen byGeorg Schmolzer

Age: < 18

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: University of Alberta

No Placebo Group

Trial Summary

What is the purpose of this trial?

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 mortality at hospital discharge. This will be a multi-centre international cluster randomized trial.

Eligibility Criteria

This trial is for newborn infants who experience cardiac arrest in the delivery room and require cardiopulmonary resuscitation. The eligibility criteria are not fully listed, but typically include specific health conditions of the infant.

Inclusion Criteria

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.

My baby was born between 28 to 43 weeks of pregnancy.

My newborn will receive all necessary life-saving measures.

Exclusion Criteria

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

Treatment Details

Interventions

3:1 C:V (Procedure)
CC+SI (Procedure)

Trial OverviewThe study is testing two different techniques of chest compressions during cardiopulmonary resuscitation: CC+SI (Chest compression with sustained inflation) versus the standard 3:1 Compression to Ventilation ratio. It aims to determine which method better reduces mortality at hospital discharge.

Participant Groups

2Treatment groups

Experimental Treatment

Active Control

Group I: CC+SI (Chest compression during sustained inflation)Experimental Treatment1 Intervention

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.

Group II: 3:1 C:V (3:1 Compression:Ventilation ratio)Active Control1 Intervention

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.