Resuscitators who compared four simulated infant cardiopulmonary resuscitation methods favoured the three-to-one compression-to-ventilation ratio.

Aim: Suboptimal cardiopulmonary resuscitation (CPR) is associated with a poor outcome, and international guidelines state that resuscitators should optimise compression and ventilation techniques with as few interruptions as possible. We investigated compression and ventilation quality during simulated CPR with four compression-to-ventilation (C:V) methods.

Methods: In this crossover manikin study, 42 pairs of doctors, nurses, midwives and sixth-year medical students from two Norwegian hospitals provided two-minute resuscitation using the 3:1, 9:3 and 15:2 C:V methods and continuous chest compressions at 120 per minute with asynchronous ventilations (CCaV-120). We measured chest compression, ventilation mechanics and the resuscitators' preferences.

Results: C:V methods 3:1 and 9:3 provided comparable chest compressions and ventilation mechanics, whereas 15:2 produced fewer ventilations and lower minute volumes. The CCaV-120 method was significantly less effective than the 3:1 C:V ratio method: the chest compression depth was 1.9 mm lower, there were 25 fewer chest compressions and 21 fewer ventilations per minute, and the minute volume was 69 mL lower. The 3:1 C:V method also provided better coordination between resuscitators.

Conclusion: Our comparison of four simulated infant cardiopulmonary resuscitation methods favoured the 3:1 C:V method, and the multidisciplinary group of participants felt it offered the best level of coordination between resuscitators.