Impact of rescuer rotation on metrics of neonatal chest compression: a simulation study

Perinatal asphyxia may require chest compressions in newborns, where rescuer fatigue can rapidly degrade compression quality. While the latest guidelines suggest rotating compressors every 2–5 min to mitigate fatigue, the optimal interval to balance quality metrics like depth and the chest compression fraction (CCF) remains uncertain for neonates. In a manikin simulation, 60 pairs of NICU staff were assigned to perform 3 min of coordinated compressions and ventilation under one of three protocols: no rotation, 2-min rotation, or 1-min rotation. Over the 3-min period, both compression depth and pumping effect declined significantly with time in the non-rotation group. In the 2-min rotation group, compression depth showed no significant change over time, but the pumping effect decreased significantly. Only the 1-min rotation group demonstrated statistically significant preservation of the pumping effect over time. No significant difference in CCF between the 1-min and 2-min rotation groups. Rotating rescuers every minute during neonatal chest compressions significantly preserves both compression depth and pumping effect throughout resuscitation, without compromising overall compression quality. Rotating rescuers every minute during neonatal chest compressions effectively maintains both compression depth and rate, thereby preserving the vital pumping effect throughout resuscitation. Compared with a 2-min rotation interval, a 1-min rotation interval does not reduce overall chest compression fraction, further suggesting that frequent rotation does not compromise compression quality. These provide novel evidence for optimizing neonatal resuscitation protocols and offer a practical strategy for improving resuscitation quality in resource-limited settings. Our findings are consistent with prior studies underscoring the importance of frequent rescuer rotation in sustaining perfusion quality and mitigating fatigue.