Beyond fatigue: optimising cardiac compression efficacy for the asphyxiated newborn

Chest compressions are among the rarest interventions performed during neonatal resuscitation, required in fewer than 0.1% of births. 1 Effective resuscitation, including chest compressions, is crucial in reducing morbidity and mortality in these infants. 2 , 3 Assessing compression quality and its relationship to meaningful clinical outcomes has proven challenging. Much of the available evidence continues to rely on simulation or animal models rather than clinical studies. Unlike adult resuscitation, where devices are available to provide consistent chest compressions with machine precision, 4 neonatal resuscitation relies solely on clinicians. Previous neonatal manikin studies have similarly demonstrated deterioration in compression performance with prolonged resuscitation. 5 For human performance to emulate a machine-like consistency, human factors such as fatigue need to be managed.