International Liaison Committee On Resuscitation Research Articles

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

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.

National guidelines for delivery room management.

The following guideline is designed to give recommendations for the routine care of all neonates immediately after delivery, and the resuscitation and delivery room approach of all high-risk infants in light of recent literature. The guideline has been prepared as three different parts. The first part is about routine procedures that have to be performed to all healthy term and preterm infants in delivery room care. The second part summaries the basic principles of resusucitation including the latest changes that were mentioned in the International Liaison Committee on Resuscitation (ILCOR)-2015 guideline. Recommendations about the delivery room management of rare clinical conditions have been discussed in the last part. The social, medical conditions, and the resourses of Turkey have also been taken into consideration in its preparation. We hope it will be useful for all pediatricians and neonatologists for use as a essential guideline in delivery room care.

The Use of Oxygen in the Delivery Room.

* Abbreviations: ci — : confidence interval GRADE — : Grading of Recommendations Assessment, Development and Evaluation ILCOR — : International Liaison Committee on Resuscitation PICO — : population, intervention, comparator, and outcome RCT — : randomized controlled trial We hope to base our practice on the best evidence available. The International Liaison Committee on Resuscitation (ILCOR) is committed to a transparent process that allows its guideline developers as well as the subsequent guideline users to understand how the evidence base was created and how the evidence is valued. In 2015, the ILCOR adopted a process that would enable a near continuous review of resuscitation science by evaluating high-priority population, intervention, comparator, and outcome (PICO) questions.1 The process is ambitious. Knowledge synthesis units with expertise in searching scientific databases and performing systematic reviews and meta-analysis address broad PICO questions (questions that may be large and complicated or topics covering several PICO questions that can be grouped together and explored by using sensitivity or subgroup analyses). Potentially, such a systematic review will lead to a meta-analysis and a broader understanding of the available evidence. Importantly, the ILCOR has endorsed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.2 … Address correspondence to Roger F. Soll, MD, Neonatal-Perinatal Medicine Division, University of Vermont Medical Center, Smith 551, 111 Colchester Ave, Burlington, VT 05401. E-mail: roger.soll{at}uvmhealth.org

European Resuscitation Council Guidelines for Resuscitation: 2018 Update – Antiarrhythmic drugs for cardiac arrest

This European Resuscitation Council (ERC) Guidelines for Resuscitation 2018 update is focused on the role of antiarrhythmic drugs during advanced life support for cardiac arrest with shock refractory ventricular fibrillation/pulseless ventricular tachycardia in adults, children and infants. This update follows the publication of the International Liaison Committee on Resuscitation (ILCOR) 2018 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR). The ILCOR CoSTR suggests that any beneficial effects of amiodarone or lidocaine are similar. This ERC update does not make any major changes to the recommendations for the use of antiarrhythmic drugs during advanced life support for shock refractory cardiac arrest.

Relationship between body temperature, neuron-specific enolase, and clinical course in patients after out-of-hospital cardiac arrest

According to ILCOR (International Liaison Committee on Resuscitation) recommendations (released in 2003), use of therapeutic hypothermia is recommended for unconscious adult patients who have survived acardiac arrest regardless of the initial monitored cardiac rhythm. Thereby, the treatment goal is to achieve and maintain abody temperature of 32-34 °C for aperiod of 12-24 h. According to the October 2015 recommendations of the European Resuscitation Council (ERC), targeted temperature management (TTM) remains part of treatment, but, as an option, it is advised that the targeted body temperature be 36 °C rather than 32-34 °C. For anon-randomized retrospective observational study, atotal of 149 patients were treated with cardiopulmonary resuscitation (CPR) between May 1999 and September 2009. For the first 4days after CPR, data associated with demography, resuscitation, therapy (temperature course, neuron-specific enolase [NSE]) and clinical-neurological development (Glasgow Outcome Scale [GOS]) were collected. In the study, patients receiving mild hyperthermia were compared with those who did not receive hypothermia. Of the 149 patients included, 90were treated with mild hypothermia (as decided by the attending physician), while 59 received no hypothermia therapy. Assessment reveals that mild hypothermia positively influences clinical-neurological progression, but not survival. On day three and four, patients with an unfavorable neurological progression exhibited significantly increased serum levels of NSE (day4: 108.7 ± 137.3 ng/ml versus 25.5 ± 15.4 ng/ml). Patients receiving hypothermia showed lower average NSE levels compared with persons not receiving hypothermia. Furthermore, during the first 4days, their NSE values tended to increase slower (NSE value at day4: 55.9 ± 64.9 ng/ml versus 129.9 ± 174.9 ng/ml). The best cut-off-value for an unfavorable neurological result was 74.2 ng/ml at day four (specificity 100%, sensitivity 48.6%). For the group of patients who received hypothermia, the best cut-off-value was 74.2 ng/ml at day four (specificity 100%, sensitivity 40.9%), and, for the comparison group, best cut-off-value was 25.5 ng/ml at day three (specificity 100%, sensitivity 88.2%). After out-of-hospital resuscitation, there is a trend for improved clinical-neurological progression with mild hypothermia but it does not influence the prognostic significance of serum NSE. After assessment of available data, it is not possible to recommend uniform cut-off values for patients who received mild therapeutic hypothermia and for those who did not receive hypothermia treatment.

Predictive factors for intensive birth resuscitation in a developing-country: a 5-year, single-center study

Objective: To identify risk factors outlined in the International Liaison Committee on Resuscitation (ILCOR) 2010 guideline and requirement for high-intensity resuscitation.Study design: A retrospective cross-sectional study of infants born to high-risk mothers from 2011 to 2015.Results: Totally 11,446 infants were analyzed; 37% were preterm, 36% were low-birth weight infants or less. 1506 infants required respiratory support; 82 (0.7%) and 61 (0.5%) infants needed chest compression and/or epinephrine. Very-preterm infants received more intensive resuscitation than moderate preterm or term infants. Breech presentation, maternal infection and maternal diabetes were significantly associated with need for respiratory support. Fetal anomalies, breech presentation, oligohydramnios, and multiple gestation were significantly associated with need for hemodynamic support.Conclusion: Most infants defined in the ILCOR 2010 guideline required nonintensive ventilation. Very-preterm infants, fetal anomalies, and breech presentation necessitate neonatal attendance at delivery. In developing countries, maternal infection and diabetes remain high-risk criteria despite deletion from the ILCOR 2016 guideline.

Yield of meconium in non-vigorous neonates undergoing endotracheal suctioning and profile of all neonates born through meconium-stained amniotic fluid: a prospective observational study

ABSTRACTBackground: Delivery room management of infants born via meconium-stained amniotic fluid (MSAF) is quite controversial. No study has tried to quantify the amount of meconium that can be aspirated from the trachea of a non-vigorous neonate born through MSAF.Aims: To study the yield of meconium in non-vigorous neonates born through MSAF undergoing endotracheal (ET) suctioning.Methods: This was a prospective observational study conducted from 1 March 2015 to 31 October 2015. A total of 760 neonates born through MSAF were enrolled. All non-vigorous neonates underwent ET suctioning. Meconium aspirated was quantified as nil (no meconium aspirated), insignificant (when only streaks of meconium were present in the ET tube), minimal (when the whole length of ET tube was filled with meconium) and significant (when the whole ET tube was filled with meconium and it poured into the suction tubing or when repeat suctioning was required).Results: The amount of meconium aspirated from the trachea was nil to insignificant in 46% of the neonates who underwent tracheal suctioning. Only 14.4% of the neonates had significant meconium aspirated from the trachea. Almost 46% of the non-vigorous infants underwent tracheal suctioning without any important amount of meconium being aspirated from the trachea.Conclusion: The study further supports the recommendation put forth by the International Liaison Committee on Resuscitation (ILCOR) 2015 that selective intubation and tracheal suctioning of non-vigorous MSAF neonates might be of limited benefit.Abbreviations: ET: endotracheal; ILCOR: International Liaison Committee on Resuscitation; HIE: hypoxic ischaemic encephalopathy; LMIC: low- and middle-income countries; MAS: meconium aspiration syndrome; MSAF: meconium-stained amniotic fluid; NRP: neonatal resuscitation programme; PPHN: persistent pulmonary hypertension of the newborn; RCT: randomised controlled trial.

Rationale and design of: A Randomized tRial of Expedited transfer to a cardiac arrest center for non-ST elevation out-of-hospital cardiac arrest: The ARREST randomized controlled trial

Out-of-hospital cardiac arrest (OHCA) is a global public health issue. There is wide variation in both regional and inter-hospital survival rates from OHCA and overall survival remains poor at 7%. Regionalization of care into cardiac arrest centers (CAC) improves outcomes following cardiac arrest from ST elevation myocardial infarction (STEMI) through concentration of services and greater provider experience. The International Liaison Committee on Resuscitation (ILCOR) recommends delivery of all post-arrest patients to a CAC, but that randomized controlled trials are necessary in patients without ST elevation (STE). Following completion of a pilot randomized trial to assess safety and feasibility of conducting a large-scale randomized controlled trial in patients following OHCA of presumed cardiac cause without STE, we present the rationale and design of A Randomized tRial of Expedited transfer to a cardiac arrest center for non-ST elevation OHCA (ARREST). In total 860 patients will be enrolled and randomized (1:1) to expedited transfer to CAC (24/7 access to interventional cardiology facilities, cooling and goal-directed therapies) or to the current standard of care, which comprises delivery to the nearest emergency department. Primary outcome is 30-day all-cause mortality and secondary outcomes are 30-day and 3-month neurological status and 3, 6 and 12-month mortality. Patients will be followed up for one year after enrolment. Post-arrest care is time-critical, requires a multi-disciplinary approach and may be more optimally delivered in centers with greater provider experience. This trial would help to demonstrate if regionalization of post-arrest care to CACs reduces mortality in patients without STE, which could dramatically reshape emergency care provision.

Out-of-hospital arrests attending an Australian tertiary paediatric emergency department over 13 years: An observational study.

In paediatric cardiopulmonary arrest, International Liaison Committee on Resuscitation (ILCOR) states, 'there are no simple guidelines to determine when resuscitative efforts become futile'. Considerations to assist this decision-making include cause of arrest, pre-existing medical conditions, age, site of arrest, duration of untreated cardiopulmonary arrest, witnessed arrest and presence of shockable rhythm. Outcomes are poor in out-of-hospital cardiac arrests (OHCA), particularly for infants. This single-centre observational study describes the characteristics and outcomes of the subgroup of children presenting to our hospital's ED following OHCA still receiving cardiac compressions, to assist development of guidelines for future resuscitation efforts in our ED, particularly for cessation of cardiopulmonary resuscitation (CPR). The ED database was searched for children presenting in cardiopulmonary arrest receiving cardiac compressions. Data were reviewed on pre-hospital, ED and hospital management and outcome, particularly looking at considerations outlined by ILCOR. From January 2000 to December 2013, 60 children were identified: median age 1.71 years; 87% arresting at home; 68% with bystander CPR; median CPR duration pre-hospital 42 min, and in ED 19.5 min; total CPR median 61 min. Fifty patients (83%) died in ED, 10 (17%) were admitted to intensive care but all died within 4 days. Children presenting to ED still receiving cardiac compressions following OHCA had a universally poor outcome, regardless of age and underlying cause. This implies resuscitative efforts could be discontinued earlier in this subgroup. A national, multicentre study is needed to determine if this finding is reproducible with a larger population.

The Contribution of Taiwan in International Liaison Committee on Resuscitation Consensus on Science and Treatment Recommendation 2015 (ILCOR CoSTR 2015).

Taiwan has begun its board certification of emergency medicine since 1998. The scholars have also devoted themselves to research in the related fi elds including resuscitation for decades. On the other hand, International Liaison Committee on Resuscitation (ILCOR) was established to build up international expert consensus on resuscitation science in 1992. The National Resuscitation Council of Taiwan (NRCT) is a multidisciplinary organization and becomes one of the founding members of the Resuscitation Council of Asia (RCA) in 2005, whereas the RCA has also become currently the final regional member of ILCOR. Under these international platforms, the experts from Taiwan have significant contributions in establishment of evidence review and clinical guidelines on resuscitation such as ILCOR Consensus on Science and Treatment Recommendation (CoSTR). This brief review will introduce explicitly these important Taiwan investigations cited in ILCOR CoSTR 2015.

The present and future of cardiac arrest care: international experts reach out to caregivers and healthcare authorities.

The purpose of this review is to describe the epidemiology of out-of-hospital cardiac arrest (OHCA), disparities in organisation and outcome, recent advances in treatment and ongoing controversies. We also outline the standard of care that should be provided by the critical care specialist and propose future directions for cardiac arrest research. Narrative review with contributions from international resuscitation experts. Although it is recognised that survival rates from OHCA are increasing there is considerable scope for improvement and many countries have implemented national strategies in an attempt to achieve this goal. More resources are required to enable high-quality randomised trials in resuscitation. Increasing international collaboration should facilitate resuscitation research and knowledge translation. The International Liaison Committee on Resuscitation (ILCOR) has adopted a continuous evidence review process, which facilitate the implementation of resuscitation interventions proven to improve patient outcomes.

Application of targeted temperature management in the treatment of cardiac arrest in adult patients

Cardiac arrest (CA) is a fatal condition with low resuscitation rate and high mortality rate. Most of the survivors have neurological sequelae affecting their quality of life. Targeted temperature management (TTM) has been suggested by a number of studies to increase the survival rate and improve neurological outcome of CA. It is highly recommended by the International Liaison Committee on Resuscitation (ILCOR) for unconscious patients after resuscitation. In this review, we discuss the pathological mechanism of brain injury in CA and applications of TTM in adults with CA, with the aim of providing valuable information for clinical application.

“All citizens of the world can save a life” — The World Restart a Heart (WRAH) initiative starts in 2018

“All citizens of the world can save a life”. With these words, the International Liaison Committee on Resuscitation (ILCOR) is launching the first global initiative – World Restart a Heart (WRAH) – to increase public awareness and therefore the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest. In most of the cases, it takes too long for the emergency services to arrive on scene after the victim’s collapse. Thus, the most effective way to increase survival and favourable outcome in cardiac arrest by two- to fourfold is early CPR by lay bystanders and by “first responders”. Lay bystander resuscitation rates, however, differ significantly across the world, ranging from 5 to 80%. If all countries could have high lay bystander resuscitation rates, this would help to save hundreds of thousands of lives every year. In order to achieve this goal, all seven ILCOR councils have agreed to participate in WRAH 2018. Besides schoolchildren education in CPR (“KIDS SAVE LIVES”), many other initiatives have already been developed in different parts of the world. ILCOR is keen for the WRAH initiative to be as inclusive as possible, and that it should happen every year on 16 October or as close to that day as possible. Besides recommending CPR training for children and adults, it is hoped that a unified global message will enable our policy makers to take action to address the inequalities in patient survival around the world.

The Uses of Lyric in Orlando Furioso

The Uses of Lyric in Orlando Furioso Ayesha Ramachandran In the famous, central canto 23 of Ludovico Ariosto’s romance-epic, as Orlando descends into madness, the poem moves into a distinctly Petrarchan landscape. The selva oscura of desire, of Dante and of Donato’s dispersed self, gives way to the “liete piante, verdi erbe, limpide acque” of the Rerum vulgarium fragmenta.1 Searching for his beloved, Orlando comes upon a locus amoenus beside a stream where he sees the names of Angelica and Medoro entwined together and engraved on the trees; in a nearby cave, he then finds the fatal inscription in Arabic that will undo him. As the terrible meaning of Medoro’s poem, a bad Petrarchan imitation, sinks in, Ariosto describes Orlando’s reaction in terms that also draw on the canzoniere: . . . vedea piú chiaro e piano:et ogni volta in mezzo il petto afflittostingersi il cor sentia con fredda mano.Rimase al fin con gli occhi e con la menteFissi nel sasso, al sasso indifferente. (OF 23.111.4–8) The anti-Petrarchism of this celebrated scene, often imitated and parodied in its own turn, is a critical commonplace.2 Medoro’s transformation of Rvf 162, “Lieti fiori et felici, et ben nate herbe” into a sensual hymn to the naked Angelica seems to emblematize Ariosto’s [End Page 112] parody and critique of Petrarchism, already set up in the earlier Alcina episode and repeated across the poem’s interweaving threads. Less noted, however, is Ariosto’s allusion to Petrarch’s canzone delle metamorfosi, Rvf 23. The feeling of a “fredda mano” seizing Orlando’s heart, transforming him, metaphorically, into a stone directly echoes Petrarch’s own metamorphosis: Questa che col mirar gli animi furaM’aperse il petto, e ’l cor prese con mano,Dicendo a me «Di ciò non far parola».Poi la rividi in altro habito sola,Tal ch’i’ non la conobbi, o senso humano,Anzi le dissi ’l ver pien di paura.Ed ella ne l’usata sua figuraTosto tornando fecemi, oimè lasso,D’un quasi vivo, et sbigottito sasso. (Rvf 23, lines 72–80)3 Noting the strangeness of this allusion, Maria Cristina Cabani, in the only full-length study of Ariosto’s relation to Petrarch and Petrarchism, suggests that Rvf 23 might be a crucial source for interpreting Canto 23 by providing a “prolungato supporto narrativo” but stops short of explaining exactly how the Petrarchan intertext maps on to the concerns of Ariosto’s poem (Cabani 262–64). The details are indeed richly suggestive: the numerological patterning of canto and canzone (23), both of which explore the dispersal and constitution of a self through poetry; the triangulation of Petrarch and Ovid, which allows Ariosto to practice his favorite mode of imitating an imitation; the counterpointing of a derivative petrarchistic discourse in Medoro’s lyric against the true Petrarchan original, associated here with Orlando; the play of literal and metaphoric levels in poetic figuration between Ariosto, Petrarch and Ovid. But before turning to a reading of this episode, it is worth reflecting on why Petrarch—and more generally, lyric poetry—has not been considered a significant critical subject in the history of the Furioso’s interpretation and critical tradition. While the poem’s many Petrarchan citations, allusions, and evocations have certainly been glossed, they have not been integrated into overarching accounts of the Furioso’s political and ethical themes. The Furioso is saturated in its very lexical fabric with traces of Petrarch: it is practically a commonplace to speak [End Page 113] of Ariosto’s revisions at the level of language and style, particularly in the 1532 version of the poem, as strongly influenced by the Petrarchism of Bembo.4 And of course, even a casual reader of the poem immediately grasps the comic parodies of Petrarchan excess that mark the poems many laments, innamorati, love-wounds, and erotic torments. But are the plural Petrarchisms of the Furioso—and by extension, its many dalliances with lyric poetics in the form of lyrical interludes and intertextual engagements with classical lyricists such as Catullus, Horace, and Ovid—anything more than a matter of style or formal affectation? How might...

Editorial for the paper of Dr. Hans Kirkegaard et al. JAMA 2017;318:341-50

The International Liaison Committee on Resuscitation (ILCOR) published the Consensus of Science for Treatments and Recommendations (CoSTR) 2015, a body of systematic reviews on resuscitation science. According to the CoSTR, Guidelines 2015 have been developed in several countries, in which targeted temperature management (TTM) at 33 to 36 ℃ has been recommended in unconscious victims after out-of-hospital cardiac arrest (OHCA) at least for 24 hours, but the optimal duration for TTM was unclear. Dr. Hans Kirkegaard et al . has tested a hypothesis in an international multicenter randomized control trial (RCT) whether TTM at 33 ℃ for 48 hours could bring more favorable outcomes as compared to that for 24 hours in patients at six months after OHCA from a presumed cardiac origin, in which TTM for 48 hours did not show any benefits on neurologic outcomes over 24 hours (1). This result indicates that TTM of 33 ℃ for 24 hours could be a choice of the treatments for comatose survivors from OHCA. Regarding the ‘dosing’ of TTM duration in this study, there has already been a thoughtful and excellent editorial written by Dr. Clifton Callaway, Pittsburg Medical Center, in the same issue of JAMA. So, I would like to review the current study from a different point of view as follows.

Update for Canadian NRP providers: A case-based review.

The International Liaison Committee on Resuscitation (ILCOR) Neonatal Task Force reviews available resuscitation science every 5 years and develops guidelines which are integrated into educational programs such as the Neonatal Resuscitation Program (NRP). The most recent ILCOR Neonatal Task Force consensus guidelines were published in October 2015. The Canadian Paediatric Society's NRP Steering Committee has reviewed ILCOR guidelines alongside the 7th edition (2016) NRP materials. Using a case-based approach, this practice point highlights the main changes relating to the delivery of NRP, within the Canadian context.

Current practice in paediatric basic life support

Abstract Introduction. Although the incidence of cardiac arrest in children is much lower than in adults, the condition is still considered a major health problem with a very low chance for survival. As in adults, the timely provision of cardiopulmonary resuscitation (CPR) in children is crucial. Current guidelines for CPR in children were published along with the guidelines for CPR in adults in 2015. As in previous years, they are based on consensus provided by International Liaison Committee on Resuscitation (ILCOR). Guidelines of particular ILCOR member councils may vary and reflect regional characteristic such as different access to health care, education methods or willingness of population to provide emergency assistance. Moreover, the conditions requiring CPR in children are characterized not only by different incidence, but also by aetiology or techniques used for different age groups. Therefore, emphasis is put on simplicity and feasibility as well as on consistency with adult guidelines to improve retention of the paediatric sequences. Nurses may be first rescuers not only in health care facilities. Better understanding of CPR guidelines might help them to improve their ability to detect conditions requiring CRP and also initiate and provide effective emergency care. Aim. The aim of this study is to compare different approaches to paediatric CPR, in particular to basic life support (BLS), used in current guidelines of different ILCOR member councils. Results and conclusions. General algorithm for adult CPR may be followed for victims of all age, but in case of children, slightly different approach might have much more favourable outcome.

The implementation of cardiac arrest treatment recommendations in English acute NHS trusts: a national survey

Purpose of the studyThere are approximately 35 000 in-hospital cardiac arrests in the UK each year. Successful resuscitation requires integration of the medical science, training and education of clinicians and...

An Update on Current Resuscitation Council (UK) Guidelines.

On 15 October 2015, The Resuscitation Council (UK) published new resuscitation guidelines following the review of resuscitation science by the International Liaison Committee on Resuscitation (ILCOR). The 2015 guidelines emphasize the importance of interactions between the emergency medical dispatcher, the bystander who provides cardiopulmonary resuscitation (CPR) and the prompt deployment of an automated external defibrillator (AED); the co-ordination of these three elements is crucial to improving out-of-hospital cardiac arrest survival. Medical emergencies in dental practices are thought to occur on average once every 3−4 years per dentist in primary care. The GDC consider medical emergencies as a highly recommended topic for Continuing Professional Development (CPD) and recommend at least 10 hours in every CPD cycle. Clinical relevance: The publication of the updated guidelines serves as a reminder to the clinical team of the importance of being up to date with recognition and treatment of cardiac arrest and choking and how seamless interaction between members of both the dental and medical teams improves long-term outcomes for patients.

Changes in the international recommendations on neonatal stabilisation and resuscitation (2015)

Abstract The International Liaison Committee on Resuscitation (ILCOR) recommendations provide a universal guide of measures to support the transition and resuscitation of newborns after their birth. This guide is expected to be adapted by local groups or committees on resuscitation, according to their own circumstances. The objective of this review is to analyse the main changes, to discuss several of the controversies that have appeared since 2010, and contrasting with other national and international organisations, such as the European Resuscitation Council (ERC), the American Heart Association (AHA), or the Australian-New Zealand Committee on Resuscitation (ANZCOR). Thus, the Neonatal Resuscitation Group of the Spanish Society of Neonatology (GRN-SENeo) aims to give clear answers to many of the questions when different options are available, generating the forthcoming recommendations of our country to support the transition and/or resuscitation of a newborn after birth, safely and effectively.