Minute-by-minute rescuer rotation improves compression metrics in neonatal simulation

Chest compressions are rarely needed during neonatal resuscitation, and evidence on compression quality largely comes from simulation and animal studies. The commentary reviews a simulation study by Wang et al. that compared rotating the clinician performing compressions every minute with rotation at the currently recommended interval. The study introduced a composite “pumping effect” measure of compression efficacy.

More frequent rotation preserved compression depth and frequency and improved the composite efficacy measure over three minutes. It did not significantly increase interruptions or reduce the chest compression fraction. However, complete chest recoil was lower in the frequent-rotation group, and the composite score may not indicate improved cardiac output or perfusion.

The authors caution that frequent role changes may disrupt team workflow and may be difficult to implement during neonatal resuscitation. Applicability is also limited by the simulation setup: the manikin was intubated and ventilation used a bag-mask device without PEEP, unlike many delivery-room scenarios. Further simulation work should assess ventilation, intubation and other resuscitation tasks; these findings do not establish a reason to change clinical practice.