Neonatal Cardiopulmonary Resuscitation Research Articles

1804 Which Musical Tune Improves Synchronization of Respiratory Support During Simulated Cardio-Pulmonary Resuscitation of Neonates?

IntroductionThe need to provide chest compressions and assisted inflations occurs infrequently during neonatal resuscitation. A mannequin study of cardiopulmonary resuscitation (CPR) in adults showed that listening to music improved the...

Efficacy of Feed Forward and Feedback Signaling for Inflations and Chest Compression Pressure During Cardiopulmonary Resuscitation in a Newborn Mannequin

BackgroundThe objective of the study was to evaluate a device that supports professionals during neonatal cardiopulmonary resuscitation (CPR). The device features a box that generates an audio-prompted rate guidance (feed forward) for inflations and compressions, and a transparent foil that is placed over the chest with marks for inter nipple line and sternum with LED’s incorporated in the foil indicating the exerted force (feedback).MethodsTen pairs (nurse/doctor) performed CPR on a newborn resuscitation mannequin. All pairs initially performed two sessions. Thereafter two sessions were performed in similar way, after randomization in 5 pairs that used the device and 5 pairs that performed CPR without the device (controls). A rhythm score was calculated based on the number of CPR cycles that were performed correctly.ResultsThe rhythm score with the device improved from 85 ± 14 to 99 ± 2% (P < 0.05). In the control group no differences were observed. The recorded pressures with the device increased from 3.1 ± 1.6 to 4.9 ± 0.8 arbitrary units (P < 0.05). The second performance of the teams showed significant better results for the group with the CPR device compared to the controls.ConclusionFeed forward and feedback signaling leads to a more constant rhythm and chest compression pressure during CPR.

AP085 Neonatal cardiopulmonary resuscitation skills, a manikin study

AP085 Neonatal cardiopulmonary resuscitation skills, a manikin study

新生児蘇生法（NCPR）普及事業の現状とConsensus21への準備状況

新生児蘇生法（NCPR）普及事業の現状とConsensus21への準備状況

End-tidal CO₂ detection of an audible heart rate during neonatal cardiopulmonary resuscitation after asystole in asphyxiated piglets.

Even brief interruption of cardiac compressions significantly reduces critical coronary perfusion pressure during cardiopulmonary resuscitation (CPR). End-tidal CO₂ (ETCO₂) monitoring may provide a continuous noninvasive method of assessing return of spontaneous circulation (ROSC) without stopping to auscultate for heart rate (HR). However, the ETCO₂ value that correlates with an audible HR is unknown. Our objective was to determine the threshold ETCO₂ that is associated with ROSC after asphyxia-induced asystole. Neonatal swine (n = 46) were progressively asphyxiated until asystole occurred. Resuscitation followed current neonatal guidelines with initial ventilation with 100% O₂ followed by cardiac compressions followed by epinephrine for continued asystole. HR was auscultated every 30 s, and ETCO₂ was continuously recorded. A receiver operator curve was generated using the calculated sensitivity and specificity for various ETCO₂ values, where a positive test was defined as the presence of HR >60 bpm by auscultation. An ETCO₂ cut-off value of 14 mm Hg is the most sensitive ETCO₂ value with the least false positives. When using ETCO₂ to guide uninterrupted CPR in this model of asphyxia-induced asystole, auscultative confirmation of return of an adequate HR should be performed when ETCO₂ ≥ 14 mm Hg is achieved. Correlation during human neonatal CPR needs further investigation.

Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle: analysis of outcomes

Extracorporeal cardiopulmonary resuscitation (ECPR) in children with cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) has been reported with encouraging results. We sought to review outcomes of neonates with functional single ventricle (FSV) receiving post-cardiotomy ECPR. Forty-eight patients who required post-cardiotomy extracorporeal membrane oxygenation (ECMO) since the introduction of our ECPR protocol (January 2007-December 2009) were identified. Twenty-seven were neonates. Review of records and survival analysis were conducted. Of 27 neonates receiving post-cardiotomy ECMO 20 had FSV. Fourteen had ECPR. Ten underwent Norwood operation (NO) for hypoplastic left heart syndrome (HLHS). Four had FSV other than HLHS. Three underwent Damus-Kay-Stansel or modified NO with systemic-to-pulmonary shunt (SPS) and one SPS with anomalous pulmonary venous connection repair. Mean age and weight were 7.8 ± 2.9 days and 3.44 ± 1.78 kg, respectively. ECMO median duration was 6 days (interquartile range (IQR) 3-14). Survival to ECMO discontinuation was 79% (11 of 14 patients) and at hospital discharge was 57% (8 of 14 patients). The most common cause of death was multi-organ failure (four of six deaths). At last follow-up (median: 11 months (1-34)) 43% of patients were alive. CPR mean duration for patients with favorable versus unfavorable outcome was 38.6 ± 6.3 versus 42.1 ± 7.7 min (p = 0.12). Previously reported determinants for poorer prognosis in conventional non-rescue ECMO (such as pre-ECMO pH<7.2, renal, neurological or pulmonary hemorrhage complications, and pre- and post-vasoactive inotropic score) did not influence outcome between survivors and non-survivors (p>0.05). ECMO support in neonates with FSV requiring ECPR can result in favorable outcome in more than half of patients at hospital discharge. Aggressive strategy toward timely application of ECPR is justified. Expeditious ECPR deployment after proper patients' selection, refinement of CPR quality and use of adjunctive neuroprotective interventions, such as induced hypothermia, might further improve outcomes.

939 Participant Feedback From the Japanese Version of the Neonatal Resuscitation Program (Neonatal Cardiopulmonary Resuscitation: NCPR Course)

939 Participant Feedback From the Japanese Version of the Neonatal Resuscitation Program (Neonatal Cardiopulmonary Resuscitation: NCPR Course)

339 Pro-Inflammatory Cytokines in Csf/Balf are Similar at Compression:Ventilation Ratio 15:2 Versus 3:1 in Asphyxiated Newborn Piglets with Cardiac Arrest

Background and aim: The ideal ratio of chest compressions to ventilations (C:V ratio) during neonatal cardiopulmonary resuscitation (CPR) is unknown. The aim of the study was to investigate the C:V ratios of 15:2 and 3:1 in terms of time to return of spontaneous circulation (ROSC) and expression of pro-inflammatory cytokines in a piglet model of cardiac arrest following severe asphyxia.Methods: Twenty two Noroc pigs (age 12-36 h) were anaesthetized and mechanically ventilated followed by progressive asphyxiation until asystole occurred. CPR was performed by positive pressure ventilation (21% O2)cardiac compressions at a C:V ratio of 3:1 (n=11) or 15:2 (n=11). Protein concentrations of interleukin-1β (IL-1β) were measured in cerebrospinal fluid (CSF) and bronchoalveolar lavage fluid (BALF); and interleukin-8 (IL-8) and tumor necrosis factor-α (TNFα) were measured in BALF only using commercially available ELISA kits for porcine samples.Results: Two of the animals in each group did not achieve ROSC after 15 minutes of CPR, and were excluded from the analyses. Mean time (SD) to ROSC for the 3:1 group was 204 s (153) and 250 s (144) for the 15:2 group (p=0.52). There was no difference between the two groups in any of the cytokines measured, neither in CSF nor in BALF. (Table will be included in poster).Conclusion: Time to ROSC and expression of proinflammatory cytokines in the brain (CSF) and lungs (BALF) were comparable between groups possibly indicating that the C:V ratio of 15:2 is as safe and effective as 3:1.

A paediatric cardiopulmonary resuscitation training project in Honduras

Objectives It is possible that the exportation of North American and European models has hindered the creation of a structured cardiopulmonary resuscitation (CPR) training programme in developing countries. The objective of this paper is to describe the design and present the results of a European paediatric and neonatal CPR training programme adapted to Honduras. Materials and methods A paediatric CPR training project was set up in Honduras with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The programme was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. Results During the first phase, 24 Honduran doctors from paediatric intensive care, paediatric emergency and anaesthesiology departments attended the paediatric CPR course and 16 of them the course for preparation as instructors. The Honduran Paediatric and Neonatal CPR Group was formed. In the second phase, workshops were given by Honduran instructors and four of them attended a CPR course in Spain as trainee instructors. In the third phase, a CPR course was given in Honduras by the Honduran instructors, supervised by the Spanish team. In the final phase of independent teaching, eight courses were given, providing 177 students with training in CPR. Conclusions The training of independent paediatric CPR groups with the collaboration and scientific assessment of an expert group could be a suitable model on which to base paediatric CPR training in Latin American developing countries.

Randomized Trial of Volume Infusion During Resuscitation of Asphyxiated Neonatal Piglets

Despite its use, there is little evidence to support volume infusion (VI) during neonatal cardiopulmonary resuscitation (CPR). This study compares 5% albumin (ALB), normal saline (NS), and no VI (SHAM) on development of pulmonary edema and restoration of mean arterial pressure (MAP) during resuscitation of asphyxiated piglets. Mechanically ventilated swine (n=37, age: 8 +/- 4 d, weight: 2.2 +/- 0.7 kg) were progressively asphyxiated until pH <7.0, Paco2 >100 mm Hg, heart rate (HR) <100 bpm, and MAP <20 mm Hg. After 5 min of ventilatory resuscitation, piglets were randomized blindly to ALB, NS, or SHAM infusion. Animals were recovered for 2 h before euthanasia and lung tissue sampled for wet-to-dry weight ratio (W/D) as a marker of pulmonary edema. SHAM MAP was similar to VI during resuscitation. At 2 h post-resuscitation, MAP of SHAM (48 +/- 13 mm Hg) and ALB (43 +/- 19 mm Hg) was higher than NS (29 +/- 10 mm Hg; p=0.003 and 0.023, respectively). After resuscitation, SHAM piglets had less pulmonary edema (W/D: 5.84 +/- 0.12 versus 5.98 +/- 0.19; p=0.03) and better dynamic compliance (Cd) compared with ALB or NS (Cd: 1.43 +/- 0.69 versus 0.97 +/- 0.37 mL/cm H2O, p=0.018). VI during resuscitation did not improve MAP, and acute recovery of MAP was poorer with NS compared with ALB. VI was associated with increased pulmonary edema. In the absence of hypovolemia, VI during neonatal resuscitation is not beneficial.

Use and Efficacy of Endotracheal Versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room

Use and Efficacy of Endotracheal Versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room

Nuevas recomendaciones para el registro uniforme de datos en la reanimación cardiopulmonar avanzada. Estilo Utstein pediátrico

Pediatric patients requiring cardiopulmonary resuscitation show high morbidity and mortality. There are few studies on this topic and existing studies use distinct terminology and methodology in data collection, hampering comparisons, efficiency assessment, and meta-analyses, etc. Consequently, in clinical studies of cardiorespiratory arrest (CRA) and cardiopulmonary resuscitation (CPR) in the pediatric age group, data collection should be performed in a uniform manner. To define the criteria that allow uniform data collection, in 2004 a working group of the International Liaison Committee on Resuscitation published simplified recommendations for registering essential information, which could be applicable to adults and children both in clinical practice and research, as well as inside and outside the hospital setting. Following the Utstein style, the Spanish Group of Pediatric and Neonatal CPR has designed an algorithm and a data collection form for recording essential CPA data. The need for these documents to be designed with maximum accuracy is stressed, both because of their medico-legal and professional implications and because of the influence of some variables on post-CPA recovery. Likewise, while protecting patient confidentiality, provincial, regional and national CPA registries should be developed, which would improve the quality of care, research, and resource provision according to needs.

Use and Efficacy of Endotracheal Versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room

Given the paucity of information regarding endotracheal epinephrine for newborn resuscitation, the objectives of this study were: (1) to determine the frequency of endotracheal epinephrine use in newborns in the delivery room, and (2) to determine whether the previously recommended dose of 0.01 to 0.03 mg/kg of endotracheal epinephrine is effective in establishing a return of spontaneous circulation. A retrospective review was conducted for all neonates who received > or = 1 dose of epinephrine in the delivery room between January 1999 and December 2004. Infants who received > or = 1 dose of endotracheal epinephrine in the delivery room during resuscitation were included in the study population whether or not they survived to be admitted to the NICU. Exclusion criteria included lethal congenital anomalies, delivery outside the hospital, and missing medical charts. Of 93,656 infants, 52 neonates (0.06%) received epinephrine in the delivery room, 5 of whom met exclusion criteria. Of the remaining 47 infants, 44 (94%) received the first dose via the endotracheal tube. Only 14 (32%) of 44 achieved return of spontaneous circulation after endotracheal tube administration of epinephrine. Of the 30 remaining infants, 23 (77%) had return of spontaneous circulation with intravenous epinephrine after initially failing endotracheal tube epinephrine. There were no differences in clinical characteristics between newborns who responded to endotracheal tube versus intravenous epinephrine except for a lower blood glucose on NICU admission (52 vs 113 mg%). Endotracheal epinephrine is frequently used when intensive resuscitation is required in the delivery room. The previously recommended endotracheal epinephrine dose of 0.01 to 0.03 mg/kg is often ineffective. Higher endotracheal doses will likely be needed to improve efficacy. A prospective study is needed to determine the best endotracheal epinephrine dosing regimen. Until such information is available, intravenous administration should be the preferred route of delivery.

Follow-up into young adulthood after cardiopulmonary resuscitation in term and near-term newborn infants. II. Neuropsychological consequences.

Brain injury after neonatal cardiopulmonary resuscitation in the term baby is often described as an all-or-nothing phenomenon, but little is known about possible late cognitive consequences. The aim of this study was therefore to investigate whether children who needed cardiopulmonary resuscitation because of presumed mild and moderate intra-partum asphyxia with no evidence of neurological impairments at 18 mo of age may display neuropsychological impairments later in life. A long-term follow-up of young adults was carried out. A blinded comprehensive neuropsychological assessment of the main aspects of cognitive functions was made. The subjects who were resuscitated were divided into two groups according to the clinical course: 20 cases with mild asphyxia and 11 cases with moderate asphyxia, all followed prospectively and compared with 18 healthy controls. The 31 subjects were born at term or near-term and selected randomly from 59 infants born in 1969-1978 at Sahlgren's Hospital, Göteborg. All infants with early neurological impairments were excluded. No major differences could be established between the two clinical groups and normal controls in any aspects of cognitive function or intelligence. All the groups performed within the normal range in all tests. A tendency toward minor deficits in verbal ability in the mild group compared to the controls was found. Only one subject had a clear, defined memory deficit. Infants who underwent cardiopulmonary resuscitatation at birth without neurological deficits at 18 mo of age did not show any cognitive deficits or neuropsychological impairments in adulthood even though inferior performance on some verbal subtests was observed compared to the control group.

Follow‐up into young adulthood after cardiopulmonary resuscitation in term and near‐term newborn infants. II. Neuropsychological consequences

Aim: Brain injury after neonatal cardiopulmonary resuscitation in the term baby is often described as an all‐or‐nothing phenomenon, but little is known about possible late cognitive consequences. The aim of this study was therefore to investigate whether children who needed cardiopulmonary resuscitation because of presumed mild and moderate intra‐partum asphyxia with no evidence of neurological impairments at 18 mo of age may display neuropsychological impairments later in life. Methods: A long‐term follow‐up of young adults was carried out. A blinded comprehensive neuropsychological assessment of the main aspects of cognitive functions was made. The subjects who were resuscitated were divided into two groups according to the clinical course: 20 cases with mild asphyxia and 11 cases with moderate asphyxia, all followed prospectively and compared with 18 healthy controls. The 31 subjects were born at term or near‐term and selected randomly from 59 infants born in 1969–1978 at Sahlgren's Hospital, Göteborg. All infants with early neurological impairments were excluded. Results: No major differences could be established between the two clinical groups and normal controls in any aspects of cognitive function or intelligence. All the groups performed within the normal range in all tests. A tendency toward minor deficits in verbal ability in the mild group compared to the controls was found. Only one subject had a clear, defined memory deficit. Conclusions: Infants who underwent cardiopulmonary resuscitatation at birth without neurological deficits at 18 mo of age did not show any cognitive deficits or neuropsychological impairments in adulthood even though inferior performance on some verbal subtests was observed compared to the control group.

Adult outcome following neonatal cardiopulmonary resuscitation

Adult outcome following neonatal cardiopulmonary resuscitation

Pediatric resuscitation guidelines in the new millennium.

In year 2000, American Heart Association published the new guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. The new guidelines are the consensus of American Heart Association & International Liaison Committee on Resuscitation. There are a number of new changes concerning the knowledge and skills for the performance of basic and advanced cardiopulmonary resuscitation in adults, pediatric and neonatal patients based on evidence-based medicine principle. The new guidelines re-emphasize the importance of sequential ABCD approach during cardiopulmonary resuscitation and include many new changes resulting from the growing knowledge and skills concerning pediatric and neonatal cardiopulmonary resuscitation in recent years. As with previous editions of Pediatric Advanced Life Support & Neonatal Resuscitation Program textbooks, the pediatric and neonatal parts of the new guidelines were the collaborative efforts of subcommittees with members from American Heart Association, American Academy of pediatrics and the International Liaison Committee on Resuscitation. For each step, the new advances in the past few years were considered and discussed and were included in the new guidelines if scientific merit existed. The new changes are discussed and summarized within the text of the article, and in the end there is a table briefly listing all the major changes of cardiopulmonary resuscitation in the pediatric and neonatal aspects. The readers may find the latest editions of Pediatric Advanced Life Support & Neonatal Resuscitation Program textbook and correlate the specific steps mentioned in this article with the original previous edition of textbook so a full scale of the new way to conduct cardiopulmonary resuscitation in pediatric patients may be undertaken.

NEONATAL CARDIOPULMONARY RESUSCITATION: THE GOOD NEWS AND THE BAD

Many health care professionals all over the world have been taught neonatal cardiopulmonary resuscitation (CPR) using the neonatal CPR course based upon the work of Bloom and Cropley. The purpose of this article is to provide a retrospective review of the development of some of the neonatal CPR techniques, to discuss current techniques and to complement the dedication of this issue to Dr. Ronald Brown and Catherine Copley, MN, RN.

Prenatal diagnosis of Klippel–Trénaunay–Weber syndrome as a cause forin utero heart failure and severe postnatal sequelae

Ultrasound examination led to prenatal diagnosis of Klippel-Trénaunay-Weber syndrome complicated by early fetal congestive heart failure. The postnatal course was complicated by the Kasabach-Merritt syndrome of thrombocytopenia due to platelet consumption within the haemangioma. There was need for neonatal cardiopulmonary resuscitation and limb amputation.

Why Change the Compression and Ventilation Rates During CPR in Neonates?

The 1985 American Heart Association National Conference for Emergency Cardiac Care (ECC) recommendations for neonatal cardiopulmonary resuscitation included a chest compression rate of 120/minute accompanied by ventilation at a rate of 40 to 60/minute.1 There was no attempt to coordinate ventilation and compression. Rescuers providing chest compression and those providing ventilation were taught to perform their tasks independently, resulting in frequent simultaneous compression and ventilation. At the time, much of the available data indicated that simultaneous compression and ventilation (SVC-CPR) resulted in improved blood flow.2-6