Neonatal Cardiopulmonary Resuscitation Research Articles

Post-cardiotomy Rescue Extracorporeal Cardiopulmonary Resuscitation in Neonates with Single Ventricle after Intractable Cardiac Arrest: Attrition after Hospital Discharge and Predictors of Outcome

Extracorporeal cardiopulmonary resuscitation (ECPR) in children with cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) has been reported with encouraging results. We reviewed outcomes of neonates with functional single ventricle (FSV) surviving post-cardiotomy ECPR after hospital discharge.

Health promoting hospitals: A case study in Iran

Introduction: Hospitals are the best ground for providing health promotion and prevention services besides health care services. This study aimed to determine the impact of establishing standards of health promoting hospitals on hospitals' indicators in one of the public hospitals of Iran. Materials and methods: This research was a case-control study that included Fatemieh (case group) and Khatam-Al-Anbia (control group) hospitals. The standards of health promoting hospitals were established as independent variables in the case hospital. The collected data were related to the indicators of neonatal mortality, cardiopulmonary resuscitation (CPR), patient satisfaction and patient education in both hospitals in the second half of 1391(20122013) and the first half of 1392(2013). Then, SPSS version 16 was used to analyze the data through Chi-Square and t tests and the results were displayed as comparing tables. Results: With regard to establishing standards of health promoting hospitals in the case hospital the total score of these standards was 72.26±4.1. The results indicated that establishing health promoting standards did not affect the neonatal mortality rate while it significantly affected success of cardiopulmonary resuscitation, patient satisfaction and the mean scores of patient education (P=0.001). Conclusion: Preliminary results after establishing standards of health promoting hospitals represented positive effects in the case hospital and these standards led to improvement of some indicators.

Are the current guideline recommendations for neonatal cardiopulmonary resuscitation safe and effective?

A recently published review of approaches to optimize chest compressions in the resuscitation of asphyxiated newborns discussed the current recommendations and explored potential determinants of effective neonatal cardiopulmonary resuscitation (CPR). However, not all potential determinants of effective neonatal CPR were explored. Chest compression shallower than the current guideline recommendation of approximately 33% of the anterior-posterior (AP) chest diameter may be safer and more effective. From a physiological standpoint, high-velocity brief duration shallower compression may be more effective than current recommendations. The application of a 1- or 2-finger method of high-impulse CPR, which would depend on the size of the subject, may be more effective than using a 2-thumb (TT) encircling hands method of CPR. Adrenaline should not be used in the treatment of asphyxiated neonates and when necessary titrated vasopressin should be used.

Respiratory Stabilization after Delivery in Term Infants after the Update of the Japan Resuscitation Council Guidelines in 2010

Background: The Japan Resuscitation Council (JRC) updated the guidelines for neonatal cardiopulmonary resuscitation in 2010, which recommended appropriate oxygen supplementation under the assessment of oximetry, with continuous positive airway pressure (CPAP) as a consideration in the delivery room. Whether this update has resulted in an improvement of respiratory stabilization in term neonates has not been well investigated to date. Objectives: The aim of this study is to evaluate the impact of the update of the JRC Guidelines in 2010 on the frequency of respiratory support for term neonates within 24 h of life in the nursery or neonatal intensive care unit (NICU). Methods: We conducted a retrospective, single-center study using data of term neonates born between 2008 and 2009 (defined as ‘group 1', before the update of the guidelines), and between 2011 and 2012 (defined as ‘group 2', after the update of the guidelines). We compared resuscitation procedures in the delivery room and respiratory support in the nursery or NICU within 24 h of life between the two groups. Respiratory support included oxygen therapy, nasal CPAP and mechanical ventilation. Results: A total of 5,036 infants were analyzed. In group 2, oxygen administration in the delivery room was significantly decreased (38.9 vs. 22.1%, p < 0.001) and face mask CPAP in the delivery room increased (1.7 vs. 11.1%, p < 0.001). The prevalence of respiratory support within 24 h of life in the nursery or NICU increased significantly in group 2 (group 1, 6.8% vs. group 2, 16.6%, p < 0.001). Conclusions: The update of the JRC Guidelines in 2010 resulted in an increase of respiratory support for term infants within 24 h of life.

A review of approaches to optimise chest compressions in the resuscitation of asphyxiated newborns

ObjectiveProvision of chest compressions (CCs) and/or medications in the delivery room is associated with poor outcomes. Based on the physiology of perinatal asphyxia, we aimed to provide an overview of...

Effect of Different Respiratory Modes on Return of Spontaneous Circulation in a Newborn Piglet Model of Hypoxic Cardiac Arrest

Background: There are no clear evidence-based recommendations on the use of different techniques of respiratory support and chest compressions (CC) during neonatal cardiopulmonary resuscitation (CPR). Objectives: To determine the effects of different respiratory support strategies along with CC representing clinical practice on the return of spontaneous circulation (ROSC) in hypoxic newborn piglets with cardiac arrest. We hypothesized that use of a T-piece resuscitator (TPR) providing positive end-expiratory pressure (PEEP) reduces time to ROSC as compared to a self-inflating bag (SIB) without PEEP. Furthermore, we explored the effects of a ventilator providing inflations without synchrony to CC. Methods: Thirty-three newborn piglets were exposed to hypoxia until asystole occurred and randomized into three groups and resuscitated according to ILCOR guidelines: group 1 = TPR [peak inspiratory pressure (PIP)/PEEP of 25/5 cm H₂O, rate 30/min], inflations interposed between CC (3:1 ratio); group 2 = SIB (PIP of 25 cm H₂O without PEEP, rate 30/min), inflations interposed between CC (3:1 ratio), and group 3 = ventilator (PIP/PEEP of 25/5 cm H₂O, rate 30/min), CC were applied with a rate of 120/min without synchrony to inflations. Animals were supported for 120 min after ROSC. Primary outcome was time to ROSC. Results: All animals achieved ROSC. We found no significant difference in time to ROSC between groups [median (IQR); TPR: 150 s (150-210); SIB: 150 s (120-180); ventilator: 180 s (150-345)]. There was no difference in use of epinephrine, in blood gases or hemodynamic parameters during the 120-min observation time after ROSC. Conclusions: We found no significant effect of different respiratory support strategies during CPR on ROSC.

Training of neonatal cardiopulmonary resuscitation instructors.

The Consensus on Science and Treatment Recommendations 2010 supported simulation-based training for education in resuscitation. This approach has been introduced into neonatal cardiopulmonary resuscitation (NCPR) courses in Japan, but no method for teaching instructors has been established. We developed a course for training instructors of NCPR, with inclusion of an instruction practice program. The goal of the study was to evaluate the performance of instructors who completed the course. Based on problems in the conventional instructor training course (old course 1), we developed and implemented a new course. Persons who had completed an NCPR course took the new course after developing two resuscitation scenarios. The new course included lectures and instruction practice, in which participants provided instruction using these scenarios. Instruction by participants was evaluated, and knowledge, opinions and satisfaction were examined by questionnaire after the course. Activity of the participants as instructors for 6 months after certification was also evaluated. The performance of trained instructors was compared between the old and new courses. Of 143 participants in the new course, > 90% had confidence to teach NCPR, while only 50-60% of the 89 participants in the old course indicated that they could instruct on resuscitation procedures and practice (P < 0.001). All participants in the new course recognized the value of scenario practice and all were glad they had taken the course. For 6 months after certification, significantly more participants who had done the new course worked as instructors compared with those who had done the old course (60% vs 34%, P < 0.001). This is the first trial of a resuscitation training course using scenarios that participants developed themselves. A new course including instruction practice for training NCPR instructors was effective for improving instructor performance.

85: Cardiovascular Effects of Epinephrine During Neonatal Cardiopulmonary Resuscitation in a Piglet Model

85: Cardiovascular Effects of Epinephrine During Neonatal Cardiopulmonary Resuscitation in a Piglet Model

Different Techniques of Respiratory Support Do Not Significantly Affect Gas Exchange during Cardiopulmonary Resuscitation in a Newborn Piglet Model

Background: There are no evidence-based recommendations on the use of different techniques of respiratory support and chest compressions (CC) during neonatal cardiopulmonary resuscitation (CPR). Objectives: We studied the short-term effects of different ventilatory support strategies along with CC representing clinical practice on gas exchange [arterial oxygen saturation (SaO₂), arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂)], hemodynamics and cerebral oxygenation. We hypothesized that in newborn piglets with cardiac arrest, use of a T-piece resuscitator (TPR) providing positive end-expiratory pressure (PEEP) improves gas exchange as measured by SaO₂ during CPR as compared to using a self-inflating bag (SIB) without PEEP. Furthermore, we explored the effects of a mechanical ventilator without synchrony to CC. Methods: Thirty newborn piglets with asystole were randomized into three groups and resuscitated for 20 min [fraction of inspired oxygen (FiO₂) = 0.21 for 10 min and 1.0 thereafter]. Group 1 received ventilation using a TPR [peak inspiratory pressure (PIP)/PEEP of 20/5 cm H₂O, rate 30/min] with inflations interposed between CC (3:1 ratio). Group 2 received ventilation using a SIB (PIP of 20 cm H₂O without PEEP, rate 30/min) with inflations interposed between CC (3:1 ratio). Group 3 received ventilation using a mechanical ventilator (PIP/PEEP of 20/5 cm H₂O, rate 30/min). CC were applied with a rate of 120/min without synchrony to inflations. Results: We found no significant differences in SaO₂ between the three groups. However, there was a trend toward a higher SaO₂ [TPR: 28.0% (22.3-40.0); SIB: 23.7% (13.4-52.3); ventilator: 44.1% (39.2-54.3); median (interquartile range)] and a lower PaCO₂ [TPR: 95.6 mm Hg (82.1-113.6); SIB: 100.8 mm Hg (83.0-108.0); ventilator: 74.1 mm Hg (68.5-83.1); median (interquartile range)] in the mechanical ventilator group. Conclusions: We found no significant effect on gas exchange using different respiratory support strategies during CPR.

Rescuer fatigue during simulated neonatal cardiopulmonary resuscitation.

To assess development of fatigue during chest compressions (CCs) in simulated neonatal cardiopulmonary resuscitation (CPR). Prospective randomized manikin crossover study. Thirty neonatal healthcare professionals who successfully completed the Neonatal Resuscitation Program performed CPR using (i) 3:1 compression:ventilation (C:V) ratio, (ii) continuous CC with asynchronous ventilation (CCaV) at a rate of 90 CC per min and (iii) CCaV at 120 CC per min for a duration of 10 min on a neonatal manikin. Changes in peak pressure (a surrogate of fatigue) and CC rate were continuously recorded and fatigue among groups was compared. Participants were blinded to pressure tracings and asked to rate their level of comfort and fatigue for each CPR trial. Compared with baseline, a significant decrease in peak pressure was observed after 72, 96 and 156 s in group CCaV-120, CCaV-90 and 3:1 C:V, respectively. CC depth decreased by 50% within the first 3 min during CCaV-120, 30% during CCaV-90 and 20% during 3:1 C:V. Moreover, 3:1 C:V and CCaV were similarly preferred by healthcare professionals. Similarly, 3:1 C:V and CCaV CPR were also fatiguing. We recommend that rescuers should switch after every second cycle of heart rate assessment during neonatal CPR.

Chest Compressions and Ventilation in Delivery Room Resuscitation

The purpose of chest compressions (CCs) is to generate blood flow to vital organs in a state in which the myocardium is unable to produce forward blood flow by internal pump mechanisms. In newborn infants requiring CCs in the delivery room, the most frequent cause of myocardial compromise is energy depletion due to hypoxia. Hypoxemia and the accompanying hypercarbia and metabolic acidosis (ie, asphyxia) causes systemic vasodilation, further compromising perfusion pressure. Hence, in neonatal cardiopulmonary resuscitation (CPR), the focus is on both reversing hypoxia and enhancing coronary and systemic perfusion pressure. There are limited clinical data to support a recommendation for how CC and ventilation should be optimized for this purpose in the newborn. However, studies in animal models and manikins suggest that using a compression-to-ventilation ratio (C:V) of 3:1 and delivering compressions during a pause in ventilation results in improved ventilation and reversal of hypoxia. Use of the 3:1 ratio, compared with higher C:V ratios, also results in more effective CC during prolonged CPR. A C:V ratio of 3:1 is perceived as more exhausting to perform than higher ratios, and a high CC rate, which may be beneficial, cannot be achieved with pauses in CCs for the delivery of ventilation. Continuous CCs and asynchronous ventilation have been shown to have improved outcomes in adults and older children after cardiac arrest, and current evidence suggests that it is as good as a 3:1 C:V ratio in neonatal resuscitation. Further studies are needed and should focus on the optimal resuscitative approach in neonatal CPR.

Application of Pituitrin in neonatal cardiopulmonary resuscitation

Objective To investigate the value of Pituitrin in neonatal cardiopulmonary resuscitation. Methods Seventy-three cases with neonatal cardiopulmonary arrest admitted in emergency department and NICU in our hospital were collected during 2007 to 2011. Newborns who did not respond to conventional neonatal resuscitation therapy were divided into two groups: epinephrine group 47 cases (control group) and Pituitrin combined with epinephrine group 26 cases (treatment group). Results There were no statistical difference (χ2=0.956, P>0.05) between treatment group and control group in the rates of initial resuscitation success (23.1%, 6/26 vs 34.0%, 16/47). Conclusion Pituitrin combined with epinephrine has similar efficacy with the use of epinephrine in neonatal cardiopulmonary resuscitation. Key words: Epinephrine; Pituitrin; Cardiopulmonary resuscitation; Newborn

How ABBA may help improve neonatal resuscitation training: Auditory prompts to enable coordination of manual inflations and chest compressions

Resuscitation guidelines recommend 90 chest compressions (CCs) and 30 inflations (INFs) per minute for neonatal cardiopulmonary resuscitation (nCPR). We hypothesised that auditory prompts would help coordinate these actions. Our aim was to investigate the effect of musical prompts during nCPR training on adherence to recommended CC and INF rates and on the quality of delivered INFs. A simulation study was conducted employing 30 experienced neonatal staff, a respiratory function monitor and a neonatal manikin. The effects of five different auditory prompts on adherence to recommended rates of CC and INF were tested against baseline (no music). The five auditory prompts (popular musical tunes) were investigated in random order. Quality of INFs was assessed by comparing the peak inflation pressures (PIP), positive end-expiratory pressures (PEEP), percentage mask leak and tidal volumes (VT). Mean baseline rates at which CCs and INFs were delivered were 80 (SD 6) per minute and 28 (SD 2) per minute, respectively. Listening to auditory prompts had varying effects on CC and INF delivery rates. For CCs, a significant difference to baseline was found only when participants listened to ABBA's 'SOS', with 86 (SD 7) per minute (P = 0.04). For INFs, we found a statistically significant improvement to baseline rate only for 'SOS', with 29 (SD 2) per minute (P = 0.04), and there was no significant difference in INF quality among the auditory prompts. Musical prompts can help with adherence to recommended CC and INF rates but do not improve the quality of INFs during nCPR training. The lasting effect of auditory prompts as musical mnemonics on nCPR performance in vivo needs to be established.

Cursos de reanimación cardiopulmonar básicos para padres de recién nacidos y lactantes

Cardiopulmonary resuscitation (CPR) courses meet all the definitions of an educational activity for prevention of cardiac arrest death by risk patients' parents and/or the general population. The aim is to improve patients' home care and turn parents confident before their children are discharged from hospital, mainly from intensive care units. Currently these courses are part of discharge protocols in many neonatologist services although there are offers that exceed this target, and extend to other areas such as education and caregivers. Locally the experience of neonatal CPR at the Sociedad Argentina de Pediatría stands out in connection with delivering courses to high risk patients' parents as well as designing and spreading learning material.

Human or monitor feedback to improve mask ventilation during simulated neonatal cardiopulmonary resuscitation

ObjectiveTo investigate if external chest compressions (ECC) increase mask leak, and if human or technical feedback improves mask ventilation during simulated neonatal cardiopulmonary resuscitation (CPR).Study designIn this observational study, 32...

Training Neonatal Cardiopulmonary Resuscitation: Can It Be Improved by Playing a Musical Prompt? A Pilot Study

Effective neonatal cardiopulmonary resuscitation (CPR) requires 3:1 coordinated manual inflations (MI) and chest compressions (CC). We hypothesized that playing a musical prompt would help coordinate CC and MI during CPR. In this pilot trial we studied the effect the "Radetzkymarsch" (110 beats per minute) on neonatal CPR. Thirty-six medical professionals performed CPR on a neonatal manikin. CC and MI were recorded with and without the music played, using a respiratory function monitor and a tally counter. Statistical analysis included Wilcoxon test. Without music, the median (interquartile range) rate of CC was 115 (100 to 129) per minute and the rate of MI was 38 (32 to 42) per minute. When listening to the auditory prompt, the rate of CC decreased significantly to 96 (96 to 100) per minute (p = 0.002) and the rate of MI to 32 (30 to 34) per minute (p = 0.001). The interquartile range of interoperator variability decreased up to 86%. Listening to an auditory prompt improved compliance with the recommended delivery rates of CC and MI during neonatal CPR.

デルファイ法による新生児蘇生法インストラクターのコンピテンシー

デルファイ法による新生児蘇生法インストラクターのコンピテンシー

1777 A Musical Mnemonic Improves the Control of Chest Compressions and Manual Ventilation During Simulated Neonatal Cardiopulmonary Resuscitation (CPR)

IntroductionGuidelines on neonatal cardiorespiratory resuscitation (CPR) suggest the provision of coordinated compressions to inflations at a rate of 3:1. However, manikin studies, and human trials have shown that coordinated chest...

1793 Effect of Chest Compressions on Mask Leak During Neonatal Resuscitation: A Manikin Study

BackgroundChest compressions during neonatal resuscitation are an infrequent event during neonatal resuscitation.ObjectivesTo investigate if chest compressions (CC) during simulated neonatal cardio-pulmonary resuscitation affect percentage of mask leak.Methods21 neonatal staff members...

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...