scholarly journals Cardiac arrest with pulseless electrical activity rhythm in newborn infants: a case series

2019 ◽  
Vol 104 (6) ◽  
pp. F572-F574 ◽  
Author(s):  
Deandra Luong ◽  
Po-Yin Cheung ◽  
Keith J Barrington ◽  
Peter G Davis ◽  
Jennifer Unrau ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiopulmonary Resuscitation ◽  
Electrical Activity ◽  
Activity Rhythm ◽  
Healthcare Providers ◽  
Newborn Infants ◽  
Case Series ◽  
Neonatal Resuscitation ◽  
Pulseless Electrical Activity ◽  
Resuscitation Guidelines

The 2015 neonatal resuscitation guidelines added ECG to assess an infant’s heart rate when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room. We report four cases of pulseless electrical activity during neonatal cardiopulmonary resuscitation in levels II–III neonatal intensive care units in Canada (Edmonton [n=3] and Winnipeg [n=1]).Healthcare providers should be aware that pulseless electrical activity can occur in newborn infants during cardiopulmonary resuscitation. We propose an adapted neonatal resuscitation algorithm to include pulseless electrical activity. Furthermore, in compromised newborns, heart rate should be assessed using a combination of methods/techniques to ensure accurate heart rate assessment. When ECG displays a heart rate but the infant is unresponsive, pulseless electrical activity should be suspected and chest compression should be started.

scholarly journals Pulseless electrical activity: a misdiagnosed entity during asphyxia in newborn infants?

2018 ◽  
Vol 104 (2) ◽  
pp. F215-F217 ◽  
Author(s):  
Sparsh Patel ◽  
Po-Yin Cheung ◽  
Anne Lee Solevåg ◽  
Keith J Barrington ◽  
C Omar Farouk Kamlin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Pulseless Electrical Activity ◽  
Heart Sounds ◽  
Carotid Blood Flow ◽  
Neonatal Piglets ◽  
Resuscitation Guidelines ◽  
Recent Case Report ◽  
The Right

BackgroundThe 2015 neonatal resuscitation guidelines added ECG as a recommended method of assessment of an infant’s heart rate (HR) when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room.ObjectivesTo compare accuracy of ECG with auscultation to assess asystole in asphyxiated piglets.MethodsNeonatal piglets had the right common carotid artery exposed and enclosed with a real-time ultrasonic flow probe and HR was continuously measured and recorded using ECG. This set-up allowed simultaneous monitoring of HR via ECG and carotid blood flow (CBF). The piglets were exposed to 30 min normocapnic alveolar hypoxia followed by asphyxia until asystole, achieved by disconnecting the ventilator and clamping the endotracheal tube. Asystole was defined as zero carotid blood flow and was compared with ECG traces and auscultation for heart sounds using a neonatal/infant stethoscope.ResultsOverall, 54 piglets were studied with a median (IQR) duration of asphyxia of 325 (200-491) s. In 14 (26%) piglets, CBF, ECG and auscultation identified asystole. In 23 (43%) piglets, we observed no CBF and no audible heart sounds, while ECG displayed an HR ranging from 15 to 80/min. Sixteen (30%) piglets remained bradycardic (defined as HR of <100/min) after 10 min of asphyxia, identified by CBF, ECG and auscultation.ConclusionClinicians should be aware of the potential inaccuracy of ECG assessment during asphyxia in newborn infants and should rather rely on assessment using a combination of auscultation, palpation, pulse oximetry and ECG.

scholarly journals Is Chest Compression Superimposed with Sustained Inflation during Cardiopulmonary Resuscitation an Alternative to 3:1 Compression to Ventilation Ratio in Newborn Infants?

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 97
Author(s):  
Seung Yeon Kim ◽  
Gyu-Hong Shim ◽  
Georg M. Schmölzer
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Spontaneous Circulation ◽  
Delivery Room ◽  
Sustained Inflation ◽  
Resuscitation Guidelines ◽  
High Incidence ◽  
Reduced Time

Approximately 0.1% for term and 10–15% of preterm infants receive chest compression (CC) in the delivery room, with high incidence of mortality and neurologic impairment. The poor prognosis associated with receiving CC in the delivery room has raised concerns as to whether specifically-tailored cardiopulmonary resuscitation methods are needed. The current neonatal resuscitation guidelines recommend a 3:1 compression:ventilation ratio; however, the most effective approach to deliver chest compression is unknown. We recently demonstrated that providing continuous chest compression superimposed with a high distending pressure or sustained inflation significantly reduced time to return of spontaneous circulation and mortality while improving respiratory and cardiovascular parameters in asphyxiated piglet and newborn infants. This review summarizes the current available evidence of continuous chest compression superimposed with a sustained inflation.

scholarly journals Delivery Room Management of Asphyxiated Term and Near-Term Infants

Neonatology ◽  
2021 ◽  
pp. 1-13
Author(s):  
Marlies Bruckner ◽  
Gianluca Lista ◽  
Ola D. Saugstad ◽  
Georg M. Schmölzer
Keyword(s):  
Preterm Infants ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Birth Asphyxia ◽  
Delivery Room ◽  
Temperature Management ◽  
Term Infants ◽  
Term Newborn ◽  
Resuscitation Guidelines ◽  
Delivery Room Management

Approximately 800,000 newborns die annually due to birth asphyxia. The resuscitation of asphyxiated term newly born infants often occurs unexpected and is challenging for healthcare providers as it demands experience and knowledge in neonatal resuscitation. Current neonatal resuscitation guidelines often focus on resuscitation of extremely and/or very preterm infants; however, the recommendations for asphyxiated term newborn infants differ in some aspects to those for preterm infants (i.e., respiratory support, supplemental oxygen, and temperature management). Since the update of the neonatal resuscitation guidelines in 2015, several studies examining various resuscitation approaches to improve the outcome of asphyxiated infants have been published. In this review, we discuss current recommendations and recent findings and provide an overview of delivery room management of asphyxiated term newborn infants.

Abstract 150: Impact of Epinephrine on ECG Changes During Resuscitation From Out-of-Hospital Cardiac Arrest With Initial Pulseless Electrical Activity

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Gunnar W Skjeflo ◽  
Eirik Skogvoll ◽  
Jan Pål Loennechen ◽  
Theresa M Olasveengen ◽  
Lars Wik ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Arrest ◽  
Electrical Activity ◽  
Multivariate Regression ◽  
Life Support ◽  
Controlled Trial ◽  
Pulseless Electrical Activity ◽  
Qrs Complex ◽  
Epinephrine Administration ◽  
Hospital Cardiac Arrest

Introduction: Presence of electrocardiographic rhythm, documented by the electrocardiogram (ECG), in the absence of palpable pulses defines pulseless electrical activity (PEA). Our aims were to examine the development of ECG characteristics during advanced life support (ALS) from Out-of-Hospital-Cardiac-Arrest (OHCA) with initial PEA, and to explore the effects of epinephrine on these characteristics. Methods: Patients with OHCA and initial PEA in a randomized controlled trial of ALS with or without intravenous access and medications were included. QRS widths and heart-rates were measured in recorded ECG signals during pauses in compressions. Statistical analysis was carried out by multivariate regression (MANOVA). Results: Defibrillator recordings from 170 episodes of cardiac arrest were analyzed, 4840 combined measurements of QRS complex width and heart rate were made. By the multivariate regression model both whether epinephrine was administered and whether return of spontaneous circulation (ROSC) was obtained were significantly associated with changes in QRS width and heart rate. For both control and epinephrine groups, ROSC was preceded by decreasing QRS width and increasing rate, but in the epinephrine group an increase in rate without a decrease in QRS width was associated with poor outcome (fig). Conclusion: The QRS complex characteristics are affected by epinephrine administration during ALS, but still yields valuable prognostic information.

scholarly journals ASSESSMENT OF HEART RATE USING AUSCULTATION AND ELECTROCARDIOGRAPHY DURING NEONATAL RESUSCITATION IN A PORCINE MODEL OF ASPHYXIA

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e27-e27
Author(s):  
Sparsh Patel ◽  
Po-Yin Cheung ◽  
Tze-Fun Lee ◽  
Jannatul Mustofa ◽  
Matteo Pasquin ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Arrest ◽  
Predictive Value ◽  
Potential Benefit ◽  
Porcine Model ◽  
Neonatal Resuscitation ◽  
Standard Of Care ◽  
Ecg Monitoring ◽  
Newborn Piglets ◽  
Resuscitation Guidelines

Abstract BACKGROUND Recent neonatal resuscitation guidelines have suggested the potential benefit of introducing Electrocardiography (ECG) to monitor neonatal heart rate (HR) as standard of care for newborns receiving respiratory support in the delivery room due to advantages over auscultation. OBJECTIVES To assess effectiveness of HR detection using either ECG or auscultation. DESIGN/METHODS We reviewed recordings from our piglet neonatal resuscitations to compare an ECG with auscultation for assessing the detection of HR at cardiac arrest. Term newborn piglets (n=41) were anesthetized, intubated, instrumented, and exposed to 40-min normocapnic hypoxia followed by asphyxia, which was achieved by clamping the endotracheal tube until asystole. Asystole was confirmed by using Electrocardiography and auscultation. RESULTS The median (±IQR) duration of asphyxia was 318 (200–560)sec. In 41 piglets both auscultation and ECG HR were assessed. In 11 (27%) cases both auscultation and ECG correctly identified a bradycardic HR (mean (SD) 32(14)/min) at the beginning of chest compression. In 11 (27%) cases both auscultation and ECG correctly identified absent of any HR. However, in 19 (46%) cases auscultation did not detect a HR while ECG did detect a HR. Overall, the Positive Predictive Value was 37%, Negative Predictive Value was 100%, Sensitivity was 100%, and Specificity was 37% for the ECG to display accurate HR during asphyxia in newborn piglets. CONCLUSION Our data illustrates the need for caution in the routine use of ECG monitoring for all neonatal who might need advanced resuscitation in the deliver room.

scholarly journals Refractory Ventricle Arrhythmias Alternating with Pulseless Electrical Activity in a Young Woman Rescued by Extracorporeal Cardiopulmonary Resuscitation

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Ilona Lálová ◽  
Lucie Filipovská ◽  
Hana Skalická ◽  
Ondřej Šmíd ◽  
Aleš Linhart ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Electrical Activity ◽  
Pulseless Electrical Activity ◽  
Myocardial Biopsy ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Case Presentation ◽  
Cardioverter Defibrillator ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Hospital Cardiac Arrest ◽  
Caucasian Female

Introduction. Extracorporeal cardiopulmonary resuscitation (ECPR) is a challenging approach for treating refractory out-of-hospital cardiac arrest (OHCA). Case Presentation. The authors describe a case of a 40-year-old Caucasian female who suffered from refractory OHCA, was admitted to a hospital while receiving ongoing cardiopulmonary resuscitation, and was connected to venoarterial extracorporeal membrane oxygenation 73 minutes after collapse. Ventricular tachyarrhythmias alternating with pulseless electrical activity resolved after eight hours. Following complete cardiac and neurological recovery, only adenoviral genome was found in myocardial biopsy. After 11 months, another episode of identical arrhythmias was rescued by an implantable cardioverter-defibrillator. Conclusion. Adequate prehospital and early hospital logistics is a prerequisite for successfully implementing extracorporeal cardiopulmonary resuscitation for refractory OHCA.

Abstract 284: Looking Back to Glance Ahead: The Impact of Last Minute's Qrs Width & Frequency in Pulseless Electrical Activity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Anders Norvik ◽  
Eirik Unneland ◽  
Gunnar W Skjeflo ◽  
David Buckler ◽  
Unai Irusta ◽  
...  
Keyword(s):  
Heart Rate ◽  
Electrical Activity ◽  
Additive Model ◽  
Pulseless Electrical Activity ◽  
Transition Intensity ◽  
Current Time ◽  
Visual Appearance ◽  
Time To Event Data ◽  
Average Transition ◽  
The Impact

Background: Observed heart rate and QRS-width during CPR in Pulseless Electrical Activity (PEA) develop differently in patients who gain ROSC compared to those who do not. In this study we investigated the impact of heart rate and QRS width on the transition from PEA to ROSC. Method: Defibrillator data from 293 episodes of cardiac arrest at two US and one Norwegian hospital were reviewed. The files contained ECG, impedance signal and compression depth. In total 178 episodes containing PEA intervals were included. Episodes with excessive ECG noise and signs of an active pacemaker were excluded. The files were processed in a MATLAB graphical application, and the clinical states were determined based on clinical documentation and the visual appearance of the ECG. ROSC was defined as an organized rhythm lasting longer than 1 minute without ongoing compressions. During pauses in compressions, heart rate and QRS-width was automatically measured and averaged over the preceding minute until current time and controlled and corrected manually. The results were analyzed using Aalen’s additive model for time-to-event data, using R version 3.6.3. Results: The average transition intensity, corresponding to the probability of gaining ROSC in one minute, was about 0.20 per min of CPR peaking at approximately 7 min. An increase in the average heart rate by 10/min increased the transition intensity by 0.03/min (p <0.01). Narrowing of the QRS in average by 100 milliseconds (ms) increased the transition intensity by 0.14/min (p <0.01). Our figure shows QRS width and heart rate for one patient with PEA approaching ROSC (gray area), with smoothed curves overlaid. Conclusion: Higher heart rates and narrower QRS complexes during PEA are strongly and significantly associated with a transition from PEA to ROSC. These changes could indicate whether a patient responds to ongoing CPR. In addition, there is a potential for predicting the immediate outcome based on these ECG characteristics.

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