Randomized trial of oxygen weaning strategies following chest compressions during neonatal resuscitation

After birth, the neonate must be immediately examined to evaluate the need for further resuscitation. Presence of an adequate respiratory effort and heart rate is vital, in addition to adequate tone and temperature. Warm, dry, and closely monitor the infant immediately after birth. Give positive pressure ventilation if there are any signs of respiratory distress or bradycardia. Low heart rate in a neonate is almost always due to hypoxia, so establish adequate ventilation as soon as possible in these cases. In cases of continued bradycardia, chest compressions and medication (epinephrine) may be necessary. Following resuscitation, transfer the neonate to an appropriate unit for continued monitoring.

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USING CHEST COMPRESSIONS WITH ASYNCHRONOUS VENTILATION AT VARIOUS CHEST COMPRESSION RATES (90, 100, 120/MIN) – A RANDOMIZED CONTROLLED ANIMAL TRIAL

Paediatrics & Child Health ◽

10.1093/pch/pxy054.071 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e27-e28

Author(s):

Sparsh Patel ◽

Po-Yin Cheung ◽

Tze-Fun Lee ◽

Matteo Pasquin ◽

Megan O’Reilly ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Porcine Model ◽

Life Support ◽

Neonatal Resuscitation ◽

Chest Compressions ◽

Neonatal Asphyxia ◽

Significant Difference ◽

Post Test ◽

The Mean

Abstract BACKGROUND The current Pediatric Advanced Life Support guidelines recommends that newborns who require cardiopulmonary resuscitation (CPR) in settings (e.g., prehospital, Emergency department, or paediatric intensive care unit, etc.) should receive continuous chest compressions with asynchronous ventilations (CCaV) if an advanced airway is in place. However, this has never been examined in a newborn model of neonatal asphyxia. OBJECTIVES To determine if CCaV at rates of 90/min or 120/min compared to current standard of 100/min will reduce the time to return of spontaneous circulation (ROSC) in a porcine model of neonatal resuscitation. DESIGN/METHODS Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 40-min normocapnic hypoxia followed by asphyxia, which was achieved by clamping the endotracheal tube until asystole. Piglets were randomized into 3 CCaV groups: chest compression (CC) at a rate of 90/min (CCaV 90,n=7), of 100/min (CCaV 100,n=7), of 120/min (CCaV 120,n=7), or sham-operated group. A two-step randomization process with sequentially numbered, sealed brown envelope was used to reduce selection bias. After surgical instrumentation and stabilization an envelope containing the allocation “sham” or “intervention” was opened (step one). The sham-operated group had the same surgical protocol, stabilization, and equivalent experimental periods without hypoxia and asphyxia. Only piglets randomized to “intervention” underwent hypoxia and asphyxia. Once the criteria for CPR were met, a second envelope containing the group allocations was opened (step two). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. RESULTS The mean (±SD) duration of asphyxia was similar between the groups with 260 (±133)sec, 336 (±217)sec, and 231 (±174)sec for CCav 90, CCaV 100, and CCaV 120, respectively (p=1.000; oneway ANOVA with Bonferroni post-test). The mean (SD) time to ROSC was also similar between groups 342 (±345)sec, 312 (±316)sec, and 309 (±287)sec for CCav 90, CCaV 100, and CCaV 120, respectively (p=1.000; oneway ANOVA with Bonferroni post-test). Overall, 5/7 in the CCaV 90, 5/7 in CCaV 100, and 5/7 in the CCaV 120 survived. CONCLUSION There was no significant difference in time to ROSC for either chest compression technique during cardiopulmonary resuscitation in a porcine model of neonatal asphyxia.

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Adding video-debriefing to Helping-Babies-Breathe training enhanced retention of neonatal resuscitation knowledge and skills among health workers in Uganda: a cluster randomized trial

Global Health Action ◽

10.1080/16549716.2020.1743496 ◽

2020 ◽

Vol 13 (1) ◽

pp. 1743496 ◽

Cited By ~ 1

Author(s):

Beatrice Odongkara ◽

Thorkild Tylleskär ◽

Nicola Pejovic ◽

Vincentina Achora ◽

David Mukunya ◽

...

Keyword(s):

Randomized Trial ◽

Health Workers ◽

Neonatal Resuscitation ◽

Cluster Randomized Trial ◽

Knowledge And Skills ◽

Helping Babies Breathe ◽

Cluster Randomized

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Chest Compressions for Bradycardia during Neonatal Resuscitation—Do We Have Evidence?

Children ◽

10.3390/children6110119 ◽

2019 ◽

Vol 6 (11) ◽

pp. 119 ◽

Cited By ~ 1

Author(s):

Agrawal ◽

Lakshminrusimha ◽

Chandrasekharan

Keyword(s):

Gas Exchange ◽

Hospital Setting ◽

Neonatal Resuscitation ◽

Cardiac Activity ◽

Intrathoracic Pressure ◽

Chest Compressions ◽

Helping Babies Breathe ◽

Liaison Committee ◽

Pediatric Study ◽

Effective Ventilation

The International Liaison Committee on Resuscitation (ILCOR) recommends the initiation of chest compressions (CC) during neonatal resuscitation after 30 s of effective ventilation if the infant remains bradycardic (defined as a heart rate less than 60 bpm). The CC are performed during bradycardia to optimize organ perfusion, especially to the heart and brain. Among adults and children undergoing cardiopulmonary resuscitation (CPR), CC is indicated only for pulselessness or poor perfusion. Neonates have a healthy heart that attempts to preserve coronary and cerebral perfusion during bradycardia secondary to asphyxia. Ventilation of the lungs is the key step during neonatal resuscitation, improving gas exchange and enhancing cerebral and cardiac blood flow by changes in intrathoracic pressure. Compressing the chest 90 times per minute without synchrony with innate cardiac activity during neonatal bradycardia is not based on evidence and could potentially be harmful. Although there are no studies evaluating outcomes in neonates, a recent pediatric study in a hospital setting showed that when CC were initiated during pulseless bradycardia, a third of the patients went into complete arrest, with poor survival at discharge. Ventilation-only protocols such as helping babies breathe are effective in reducing mortality and stillbirths in low-resource settings. In a situation of complete cardiac arrest, CC reinitiates pulmonary flow and supports gas exchange. However, the benefit/harm of performing asynchronous CC during bradycardia as part of neonatal resuscitation remains unknown.

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Volume Versus Mass Dosing of Epinephrine for Neonatal Resuscitation: A Randomized Trial

Hospital Pediatrics ◽

10.1542/hpeds.2019-0061 ◽

2019 ◽

Vol 9 (10) ◽

pp. 757-762

Author(s):

Kate D. Brune ◽

Varsha Bhatt-Mehta ◽

Deborah M. Rooney ◽

Gary M. Weiner

Keyword(s):

Randomized Trial ◽

Neonatal Resuscitation ◽

Volume Versus

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The two-thumb is superior to the two-finger method for administering chest compressions in a manikin model of neonatal resuscitation

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/adc.2009.180406 ◽

2010 ◽

Vol 96 (2) ◽

pp. F99-F101 ◽

Cited By ~ 51

Author(s):

C. Christman ◽

R. J. Hemway ◽

M. H. Wyckoff ◽

J. M. Perlman

Keyword(s):

Neonatal Resuscitation ◽

Chest Compressions

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Midwives' Evaluation of a Neonatal Resuscitation in High- and Low-Resource Settings

Frontiers in Pediatrics ◽

10.3389/fped.2021.644308 ◽

2021 ◽

Vol 9 ◽

Author(s):

Francesco Cavallin ◽

Serena Calgaro ◽

Martina Borellini ◽

Margherita Magnani ◽

Greta Beltramini ◽

...

Keyword(s):

Heart Rate ◽

Real Life ◽

Neonatal Resuscitation ◽

Educational Goals ◽

Mask Ventilation ◽

Central Hospital ◽

Chest Compressions ◽

Low Resource Settings ◽

Country Study ◽

Bag Mask Ventilation

Aim: To assess midwives' evaluation of a real-life neonatal resuscitation and their opinion on importance of resuscitation interventions.Methods: Multicenter, multi-country study.Setting: Beira Central Hospital (Mozambique) and Azienda Ospedale-Università di Padova (Italy).Subjects: Sixteen Mozambican midwives and 18 Italian midwives.Interventions: Midwives' assessment was evaluated by using a predefined score, which graded each resuscitation intervention (0–2 points) and summed to a total score for each step (initial steps, bag-mask ventilation, and chest compressions). All scores were compared with referral scores given by two expert neonatologists.Results: Both Mozambican and Italian midwives overestimated their performance regarding of initial steps taken during resuscitation, chest compressions, high-oxygen concentrations (p < 0.01), and underestimated the importance of stimulation (p < 0.05). Mozambicans overestimated suctioning (p < 0.001). Participants agreed with experts about the importance of equipment preparation, using a warmer, drying the newborn, removing wet linen and heart rate assessment.Conclusion: Mozambican and Italian midwives overestimated the performance of a real-life neonatal resuscitation, with heterogeneous evaluation of the importance of several aspects of neonatal resuscitation. These findings may be useful for identifying educational goals.

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Impact of personal protective equipment on neonatal resuscitation procedures: a randomised, cross-over, simulation study

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2021-322216 ◽

2021 ◽

pp. fetalneonatal-2021-322216

Author(s):

Francesco Cavallin ◽

Fiorenzo Lupi ◽

Benedetta Bua ◽

Marion Bellutti ◽

Alex Staffler ◽

...

Keyword(s):

Tracheal Intubation ◽

Personal Protective Equipment ◽

Healthcare Providers ◽

Neonatal Resuscitation ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Positive Pressure ◽

Protective Equipment ◽

Chest Compressions ◽

Randomised Controlled

Background and objectiveHealthcare providers should use personal protective equipment (PPE) when performing aerosol-generating medical procedures during highly infectious respiratory pandemics. We aimed to compare the timing of neonatal resuscitation procedures in a manikin model with or without PPE for prevention of SARS-COVID-19 transmission.MethodsA randomised controlled cross-over (AB/BA) trial of resuscitation with or without PPE in a neonatal resuscitation scenario. Forty-eight participants were divided in 12 consultant–nurse teams and 12 resident–nurse teams. The primary outcome measure was the time of positive pressure ventilation (PPV) initiation. The secondary outcome measures were duration of tracheal intubation procedure, time of initiation of chest compressions, correct use of PPE and discomfort/limitations using PPE.ResultsThere were significant differences in timing of PPV initiation (consultant–nurse teams: mean difference (MD) 6.0 s, 95% CI 1.1 to 10.9 s; resident–nurse teams: MD 11.0 s, 95% CI 1.9 to 20.0 s), duration of tracheal intubation (consultant–nurse teams: MD 22.0 s, 95% CI 7.0 to 36.9 s; resident–nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s) and chest compressions (consultant–nurse teams: MD 32.3 s, 95% CI 14.4 to 50.1 s; resident–nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s). Twelve participants completed the dressing after entering the delivery room. PPE was associated with visual limitations (43/48 participants), discomfort in movements (42/48), limitations in communication (32/48) and thermal discomfort (29/48).ConclusionsIn a manikin model, using PPE delayed neonatal resuscitation procedures with potential clinical impact. Healthcare workers reported limitations and discomfort when wearing PPE.Trial registration numberNCT04666233.

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