Resuscitation Techniques Research Articles

A proof-of-concept study evaluating cardiac compression techniques for cardiopulmonary resuscitation in laying hens (Gallus gallus).

To determine in adult chickens which of 3 CPR techniques, sternal compressions (SC), SC with interposed caudal coelomic compressions (ICCC), or lateral compressions (LC), results in the highest mean systolic (SAP), diastolic (DAP), and mean arterial pressure (MAP) as measured directly from the carotid artery. Prospective, nonblinded, experimental crossover study. University teaching hospital laboratory. Ten retired laying hens. Birds were sedated, anesthetized, and placed in dorsal recumbency. A carotid artery catheter was placed to directly measure arterial pressure. Ventricular fibrillation was induced with direct cardiac stimulation using a 9-Volt battery. Each bird then received 2minutes of the 3 different cardiac compression techniques in a random order by 3 different compressors, with the compressor order also randomized. Birds were subsequently administered IV epinephrine, and transthoracic defibrillation was attempted. At the end of experimentation, each bird was euthanized, and simple gross necropsies were performed. Linear mixed models followed by pairwise paired t-tests were performed to evaluate differences in pressures generated by each technique. The primary study outcomes were SAP, DAP, and MAP over 2minutes of compressions for each compression technique. Pressures from ICCC (SAP: 27.6±5.3mmHg, DAP: 18.7±5.2mmHg, MAP: 21.7±5.2mmHg) were significantly higher than those from LC (SAP: 18.9±5.4mmHg, DAP: 11.6±4.1mmHg, MAP: 14.1±4.5mmHg). Pressures from SC (SAP: 24.5±6.4mmHg, DAP: 15.2±4.3mmHg, MAP: 18.3±5.0mmHg) were not significantly different from ICCC or LC. External compressions can generate detectable increases in arterial pressure in chickens with ventricular fibrillation. SC with ICCC generated significantly higher arterial pressures than LC. SC alone generated blood pressures that were not significantly different from those generated by SC with ICCC or LC.

The Rate of Success of CPR in Patients Suffering from Cardiac Arrest in Patients Admitted in CCU in Cardiology Department Ayub Medical Teaching Institute

Cardiopulmonary resuscitation (CPR) is an essential procedure used to treat patients who are in cardiac arrest, particularly in the Critical Care Unit (CCU). Objective: To assess the success rate of CPR admitted to the CCU, revealing insight on the effectiveness of current resuscitation techniques. Methods: This retrospective study was conducted at Department of Cardiology Ayub Medical Teaching Institute, Abbottabad, between 13th April 2023 to 30th November 2023, 110 patients had cardiac arrest while in the intensive care unit. Data were gathered and examined on patient demographics, pre-existing comorbidities, time to start CPR, duration of CPR, and results. CPR success was defined as a sustained restoration of spontaneous circulation (ROSC) for at least 20 minutes. Results: This study included 110 cardiac patients. Most patients (68.18%) were male. Hypertension was the most common comorbidity at 72.7%. CPR started on average 4.8 minutes late, with a 1.2-minute standard deviation. The average CPR time was 18.2 minutes, with a 5.6-minute SD. After cardiac arrest, 60 (54.5%) patients began CPR within 5 minutes. Another subgroup found 96.0% CPR success in 25 (22.7%) ventricular fibrillation patients. Then occurred ventricular tachycardia (80.0%), pulseless electrical activity (76.0%), and asystole (68.9%). These data suggest that CPR works better in ventricular fibrillation patients. Conclusions: This research sheds light on cardiac arrest CCU patients' demographics, care, and outcomes. The data show that early CPR and ventricular fibrillation detection and treatment improve outcomes for these individuals.

Effect of maternal oxygen supplementation for parturient undergoing elective cesarean section by high-flow nasal oxygen compared with room air on fetal acidemia: study protocol for a randomized controlled trial

BackgroundMaternal oxygen supplementation is usually used as an intrauterine resuscitation technique to prevent fetal hypoxia and acidemia during delivery. However, there has been a great deal of controversy regarding the effects of prophylactic maternal oxygen during cesarean section, during which the incidence of fetal acidemia seems to be higher compared with that during labor. High-flow nasal oxygen (HFNO) can improve oxygenation better in patients with high-flow oxygen airflow. The purpose of this study is to determine whether maternal oxygen supplementation with HFNO has a positive effect on fetal acidemia during cesarean section through umbilical arterial blood gas analysis.MethodThis prospective, single-center, randomized, double-blinded trial will enroll 120 patients undergoing cesarean section. Participants will be randomly assigned to the HFNO group or air group at a 1:1 ratio. For parturients in the HFNO group, the flow rate is 40L/min, and the oxygen is heated to 37℃ with humidity 100% oxygen concentration through the Optiflow high-flow nasal oxygen system. And for the air group, the flow rate is 2 L/min with an air pattern through the same device. The primary outcome was umbilical artery (UA) lactate. Secondary outcomes include UA pH, PO2, PCO2, BE, the incidence of pH < 7.20 and pH < 7.10, Apgar scores at 1 and 5 min, and neonatal adverse outcomes.DiscussionOur study is the first trial investigating whether maternal oxygen supplementation with HFNO can reduce the umbilical artery lactate levels and the incidence of fetal acidemia in cesarean section under combined spinal-epidural anesthesia.Trial registrationClinicalTrials.gov NCT05921955. Registered on 27 June 2023.

Principles and Techniques of Apnoea Resuscitation: The Critical Importance of Prompt and Effective Intervention in Managing Respiratory Distress in Neonates - A Review

Neonatal apnea, characterized by pauses in breathing lasting more than 20 seconds, is common in preterm infants due to immature respiratory control mechanisms, posing risks such as hypoxemia and bradycardia, which can impact neurological development. This review underscores the critical need for prompt and effective intervention, ranging from non-invasive techniques like tactile stimulation to advanced methods such as positive pressure ventilation and endotracheal intubation. Despite progress, research gaps remain in optimizing non-pharmacological and pharmacological treatments, highlighting the necessity for standardized training, updated guidelines, and multidisciplinary approaches. Continuous monitoring, post-event reflection, and ongoing research are essential to improve outcomes for these vulnerable patients.

Venous Thromboembolism in Children: The Rivaroxaban Experience.

The incidence of venous thromboembolism (VTE) in the pediatric population has increased more than 10-fold in the last 20 years, as a consequence of the advancement of resuscitation and surgical techniques and the global increase in life expectancy of children suffering from chronic pathologies. Monitoring anticoagulant therapy to achieve outcomes within the target range in childhood VTE, parenteral administration of medications, and frequent blood tests in children are often cumbersome. Availability of safe and effective oral agents with pediatric data to support use would be of clear benefit. A physiologically based pharmacokinetic model was developed to estimate the appropriate dosing schedule for rivaroxaban in children. This incorporated growth/maturation and variability in anthropometrics (e.g., body height, weight, and body mass index), anatomy (e.g., organ weight), physiology (e.g., blood flow rates), metabolism and excretion. Rivaroxaban use in pediatric population underwent a complete investigational program, consisting mainly of one phase I pharmacokinetics/pharmacodynamics trial, three phase II trials, one phase III trial. The phase III trial enrolled 500 patients from birth to <18 years and documented the efficacy and safety of rivaroxaban regimens at dose equivalent to the adult 20 mg dose for the prevention of fatal or symptomatic nonfatal recurrent VTE and major bleeding versus heparin or vitamin K antagonists. Results were similar to those in rivaroxaban studies in adults. The efficacy and safety of rivaroxaban in children reported in the EINSTEIN JUNIOR trial provide further support to previous trials in adults (EINSTEIN Program), which demonstrate a favorable profile for the use of rivaroxaban for the management of VTE in challenging patient populations. Other clinical evidence contributing to the use of rivaroxaban among different risk groups in pediatric VTE population confirms the consistency with principal trial. Our review aims to describe the rationale for using rivaroxaban oral suspension in clinical practice and to summarize its multiple indications in each vascular bed (e.g., cerebral venous thrombosis, symptomatic or asymptomatic central venous catheter-associated thrombosis), etiology, and patients setting.

Intratracheal instillation of budesonide suspension versus normal saline on oxidative stress in neonates with meconium aspiration syndrome

Background Presently, the efficacy of neonatal resuscitation techniques via interventions such as oral, nasal, and endotracheal suction for preventing meconium aspiration syndrome (MAS) after delivery has not been satisfactory. Objective This study aimed to investigate the role of intratracheal instillation of budesonide on oxidative stress in MAS. Methods Sixty-two neonates with MAS admitted to Huai’an Maternity and Child Healthcare Hospital from January 2018 to June 2020 were divided into a study group (intratracheal instillation of 2 ml budesonide suspension; n = 31) and a control group (intratracheal instillation of 2 ml normal saline; n = 31). Collect data from two groups of patients and evaluate clinical outcomes, including oxygenation index (OI), as well as serum total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI) and 8-Isoprostane before treatment and 72h after admission. Results We found no statistical differences in mortality, complication rate, total oxygen inhalation time, OI before treatment and 72h after admission between the two groups of neonates with MAS, while the duration of invasive respiratory support in the study group was significantly shorter than in the control group. Also, serum TAC, TOS, OSI and 8-isoprostane levels were not statistically different before treatment between the two groups. After 72h of admission, OSI and 8-Isoprostane in neonates with MAS in the study group were much lower than those in the control group. TOS, OSI, 8-Isoprostane in the control group and 8-Isoprostane in the study group were significantly higher than those before treatment. As for TAC and TOS, no significant differences were observed between the two groups. Conclusion Intratracheal instillation of budesonide was shown to alleviate oxidative stress and shorten invasive ventilation time in neonates with MAS.

Prototype of innovative device for chest compression at the Universidad Private del Valle in Cochabamba, Bolivia

This article presents the development of a portable automatic chest compressor device using a rod-crank-piston mechanism. The main focus is on assessing the feasibility of manufacturing the device in Bolivia, primarily utilizing 3D printing technology and locally accessible components to create an economical device. The methodology involved reviewing appropriate techniques of Cardiopulmonary Resuscitation (CPR), analyzing the proposed mechanism, and researching chest compression devices available in the market for insights. Using this information as a foundation, a device inspired by the Weil Mini model was designed but implementing a rod-crank-piston mechanism for compressions. The construction of the prototype progressed through different phases, culminating in a portable device with manual control and the ability to store treatment data in a wirelessly connected application, allowing for equipment maintenance by service personnel. The conducted tests yielded satisfactory results, demonstrating that the device correctly compressed a calibrated CPR manikin, meeting all the requirements established by the American Heart Association (AHA) standards. Additionally, the development of software, implemented safety systems, and the creation of the web application for maintenance and data logging represent distinctive features of the prototype

Interdisciplinary training program for pediatric cardiorespiratory arrest using rapid cycle deliberate practice: A descriptive cross-sectional study.

cardiorespiratory arrest (CRA) is a severe public health concern, and clinical simulation has proven to be a beneficial educational strategy for training on this topic. To describe the implementation of a program for pediatric cardiac arrest care using rapid-cycle deliberate practice (RCDP), the quality of the technique employed, and participants' opinions on the methodology. This descriptive cross-sectional study of pre- and post-performance training in cardiopul monary resuscitation (CPR) techniques and reaction evaluation was conducted in a hospital in São Paulo. Multidisciplinary groups performed pediatric resuscitation in a simulated scenario with RCDP mediated by a facilitator. The study sample included professionals working in patient care. During the simulation, the participants were evaluated for their compliance with the CRA care algorithm. Further, their execution of chest compressions was assessed pre- and post-intervention. In total, 302 professionals were trained in this study. The overall quality of CPR measured pre-intervention was inadequate, and only 26% had adequate technique proficiency, whereas it was 91% (P < 0.01) post-intervention. Of the participants, 95.7% responded to the final evaluation and provided positive comments on the method and their satisfaction with the novel simulation. Of these, 88% considered that repetition of the technique used was more effective than traditional simulation. The RCDP is effective for training multidisciplinary teams in pediatric CPR, with an emphasis on the quality of chest compressions. However, further studies are necessary to explore whether this trend translates to differential performances in practical settings.

Assessing Liver Viability: Insights From Mitochondrial Bioenergetics in Ischemia-Reperfusion Injury

Orthotopic liver transplantation remains the definitive treatment for patients with end-stage liver disease. Unfortunately, the increasing demand for donor livers and the limited supply of viable organs have both led to a critical need for innovative strategies to expand the pool of transplantable organs. The mitochondrion, central to hepatic cellular function, plays a pivotal role in hepatic ischemic injury, with impaired mitochondrial function and oxidative stress leading to cell death. Mitochondrial protection strategies have shown promise in mitigating IRI and resuscitating marginal organs for transplant. Machine perfusion (MP) has been proven a valuable tool for reviving marginal organs with very promising results. Evaluation of liver viability during perfusion traditionally relies on parameters including lactate clearance, bile production, and transaminase levels. Nevertheless, the quest for more comprehensive and universally applicable viability markers persists. Normothermic regional perfusion has gained robust attention, offering extended recovery time for organs from donation after cardiac death donors. This approach has shown remarkable success in improving organ quality and reducing ischemic injury using the body's physiological conditions. The current challenge lies in the absence of a reliable assessment tool for predicting graft viability and post-transplant outcomes. To address this, exploring insights from mitochondrial function in the context of ischemia-reperfusion injury could offer a promising path toward better patient outcomes and graft longevity. Indeed, hypoxia-induced mitochondrial injury may serve as a surrogate marker of organ viability following oxygenated resuscitation techniques in the future.

SMEAR Classification of Cardiopulmonary Resuscitation Techniques and Devices

SMEAR Classification of Cardiopulmonary Resuscitation Techniques and Devices

Electric Cardioversion in Older Adults. Is Sedation Using Propofol Safe in the Absence of the Direct Anesthetist's Assistance?

Aims: This study aimed to assess the safety of electric cardioversion in the absence of anesthetists assistance. We also evaluated the efficacy and safety of this procedure in older adults (≥80 years) compared to younger populations. Methods: We retrospectively analyzed the data of patients who underwent electric cardioversion at our cardiology department. Patients were divided into 2 groups according to age: ≥ 80 years and <80 years old. Results: The study included 218 participants, 73 were aged 80 years or more (mean age: 84.8 years), and 145 were younger than 80 years (mean age: 66.7 years). Electric cardioversion was effective in 97.3% of older patients and 96.5% of younger patients (P = 1.00). No thromboembolic complications were observed in either of the groups. Asystole >5 s occurred immediately after shock in 4.1% of older and 2.1% of younger patients (P = .405). Propofol was used as a sedative, with a mean dose of 0.83 mg/kg versus 0.93 mg/kg, in older and younger patients, respectively. Intubation, medical intervention, or other advanced resuscitation techniques were not required. During hospitalization, arrhythmia recurred in 9.6% and 12.4% of the older and younger patients, respectively (P = .537). Conclusions: Electrical cardioversion is an effective and safe procedure regardless of patient age. Sedation with propofol administered by cardiologists was safe. Adverse events were not considered serious or reversible.

Moments in history illustrating approaches to the diagnosis of apparent death and the development of resuscitation techniques in the 18th century.

Moments in history illustrating approaches to the diagnosis of apparent death and the development of resuscitation techniques in the 18th century.

Damage Control Strategies For Vascular Injuries – A Report From The Amazon

Patients may sustain vascular injuries in rural areas or isolated locations, which are very common in the vast area of the Amazon rainforest. In situations like this, patients may take many hours, or even days, to get access to hospitals capable of dealing with these potentially lethal injuries, arriving in severe conditions that may require damage control strategies. Among the currently available techniques for damage control resuscitation and damage control surgery, the endovascular balloon occlusion of the aorta (REBOA) and temporary vascular shunts play an important role, but appropriate devices are often unavailable; in such scenarios, surgeons’ expertise on how to improvise devices, using more accessible materials, can be lifesaving. This paper presents a case of femoral vessel injury in a patient who required REBOA and vascular shunt improvisation; discussions regarding possible improvisation strategies are provided and technical steps on how to implement them are described.

Large Language Model (LLM)-Powered Chatbots Fail to Generate Guideline-Consistent Content on Resuscitation and May Provide Potentially Harmful Advice.

Innovative large language model (LLM)-powered chatbots, which are extremely popular nowadays, represent potential sources of information on resuscitation for the general public. For instance, the chatbot-generated advice could be used for purposes of community resuscitation education or for just-in-time informational support of untrained lay rescuers in a real-life emergency. This study focused on assessing performance of two prominent LLM-based chatbots, particularly in terms of quality of the chatbot-generated advice on how to give help to a non-breathing victim. In May 2023, the new Bing (Microsoft Corporation, USA) and Bard (Google LLC, USA) chatbots were inquired (n = 20 each): "What to do if someone is not breathing?" Content of the chatbots' responses was evaluated for compliance with the 2021 Resuscitation Council United Kingdom guidelines using a pre-developed checklist. Both chatbots provided context-dependent textual responses to the query. However, coverage of the guideline-consistent instructions on help to a non-breathing victim within the responses was poor: mean percentage of the responses completely satisfying the checklist criteria was 9.5% for Bing and 11.4% for Bard (P >.05). Essential elements of the bystander action, including early start and uninterrupted performance of chest compressions with adequate depth, rate, and chest recoil, as well as request for and use of an automated external defibrillator (AED), were missing as a rule. Moreover, 55.0% of Bard's responses contained plausible sounding, but nonsensical guidance, called artificial hallucinations, that create risk for inadequate care and harm to a victim. The LLM-powered chatbots' advice on help to a non-breathing victim omits essential details of resuscitation technique and occasionally contains deceptive, potentially harmful directives. Further research and regulatory measures are required to mitigate risks related to the chatbot-generated misinformation of public on resuscitation.

Establishing a Quality Improvement Program for Pediatric In-hospital Cardiac Arrest

Background: Pediatric In-hospital Cardiac Arrest (IHCA) is a rare event with a 50-55% mortality rate. Techniques of Cardiopulmonary Resuscitation (CPR), medication and electrical therapy timing, team dynamics, simulation and debriefing programs are associated with improved outcomes. This study aimed to improve outcomes after IHCA by describing and implementing quality improvement processes that cross and coordinate among traditional siloed pediatric resuscitation team structures. Methods: We chose three outcome measures: (1) return of spontaneous circulation (ROSC), (2) 24-hour survival after IHCA, and (3) survival to hospital discharge. Process outcomes include (1) hot debriefs performed with a standardized form, (2) code documentation using a revised form, and (3) formal code team review presented to a central Emergency Management Committee, using a standardized form. Results: One hundred and thirty-two patients experienced 176 events during the 36-month study period. Survival to hospital discharge increased from 33% during year 1 to 60% during year 2 (P &lt; 0.05) but decreased to 45% in year 3. Both hot debrief performance and code documentation process methods did not demonstrate widespread adoption, but formal code team review was documented in 80% of events quite rapidly. Conclusions: There are common traits inherent to effective CPR team response. Ensuring optimal performance of these common tasks and techniques in every pediatric IHCA event in our hospital is being addressed by committee reorganization, task simplification, new technology acquisition and enhanced feedback loops. Early outcome analysis shows initial improvement in survival to hospital discharge after pediatric IHCA.

Emergency Resuscitation Techniques:Airway, Breathing, and Circulation

Cardiac arrest causes cerebral anoxia, resulting in loss of consciousness within seconds and irreversible brain damage within 3-5 min. Emergency resuscitation is generally performed on patients in cardiopulmonary or near-cardiopulmonary arrest, i.e., life-threatening conditions, and requires rapid stabilization of the airway, breathing, and circulation(or "ABC")to maintain cerebral perfusion. Generally, the ABC approach represents the order of medical treatment for critically ill patients. It provides supportive care(resuscitation)after ensuring the flow of oxygen supply necessary to sustain life. The most important goal in emergency resuscitation is to ensure a secure airway, without which, resuscitation is hopeless. Clinicians should be prepared daily to avoid missing any opportunity to ensure a secure airway. Even in cardiac arrest, high-quality cardiopulmonary resuscitation is necessary to reduce the duration of cerebral anoxia. An algorithm for this high-quality cardiopulmonary resuscitation is described in this article.

450 Assessment of Basic Cardiopulmonary Resuscitation (CPR) technique in professionals of a Pediatric Department in a IIb level hospital. Analysis through simulation mannequins with a feedback system

450 Assessment of Basic Cardiopulmonary Resuscitation (CPR) technique in professionals of a Pediatric Department in a IIb level hospital. Analysis through simulation mannequins with a feedback system

Application Times, Placement Accuracy, andUser Ratings ofCommercially Available Manual andBattery-Powered Intraosseous Catheters ina High Bone Density Cadaveric Swine Model.

Intraosseous (IO) infusion, the pressurized injection of fluids into bone through a catheter, is a life-preserving resuscitative technique for treating trauma patients with severe hemorrhage. However, little is known regarding the application times, placement accuracy, and end-user ratings of battery-powered and manual IO access devices. This study was specifically designed to fill these knowledge gaps on six FDA-approved IO access devices. Three experienced U.S. Navy Emergency Medicine residents each placed commercially available 15-gauge IO catheters in cadaveric swine (Sus scrofa) proximal humeri and sternums in a randomized prospective experimental design. Devices included the battery-powered EZ-IO Rapid Infuser and the manual Jamshidi IO, PerSys NIO, SAM Manual IO, Tactical Advanced Lifesaving IO Needle (TALON), and PYNG First Access for Shock and Trauma 1 (30 trials per device, 10 per user, 210 total trials). Application times, placement accuracy in medullary (zone 1) and trabecular (zone 2) bone while avoiding cortical (zone 3) bone, and eight subjective user ratings were analyzed using ANOVA and nonparametric statistics at P < .05. The EZ-IO demonstrated the fastest application times, high rates in avoiding zone 3, and the highest user ratings (P < .0001). The TALON conferred intermediate placement times, highest rates of avoiding zone 3, and second-highest user ratings. The SAM Manual IO and Jamshidi performed poorly, with mixed results for the PerSys NIO and PYNG First Access for Shock and Trauma 1. The battery-powered EZ-IO performed best and remains the IO access device of choice. The present findings suggest that the TALON should be considered as a manual backup to the EZ-IO.

Validation of the knowledge evaluation questionnaire of the cardiopulmonary resuscitation training program in high school students.

There is an urgent need for generalized training in cardiopulmonary resuscitation (CPR) techniques, starting with secondary education. Validated instruments for assessing the efficacy of such interventions are not yet available. This study aimed to validate an evaluation questionnaire of a CPR training program for high school students, to analyze the levels of readability, difficulty, reliability, and content validity, as well as the fit the purpose for which they were designed, the trait they are intended to measure. An instrumental study was conducted in 2 phases. In the first phase, an inter-judge validation was carried out with 11 experts in CPR accredited instructors of basic and advanced CPR by the American Heart Association. In the second phase, the psychometric properties were evaluated from the perspective of Item Response Theory. During May of the 2017/18 and 2018/19 academic years, 259 4th-year secondary school students from a high school in the southeastern area of the island of Gran Canaria (mean age: 15.78 years; 50.60% male) were surveyed anonymously using the questionnaire to be validated. The questionnaire was easily readable (74.12 Flesch-Szigriszt Index); the difficulty level (Easy/Very Easy) in the context of this secondary school level of education and the ability level of the respondents overlapped sufficiently and there was no gender bias. The questionnaire was able to discriminate between respondents of slightly more than 7 levels of expertise, from low knowledge of CPR to high knowledge of CPR (Separation Index 7.53). The model fit was excellent (infit = 1/outfit = 1.01). The content validity index was adequate. The separation index and reliability exceeded what was considered adequate for guaranteed use. The level of difficulty of the items and the level of ability of the respondents is in line with the educational level of the students. The questionnaire did not produce a gender bias in response probability. The questionnaire is easily understandable and can discriminate between different levels of ability without differential gender bias, and its reliability is outstanding, as it exceeds the minimum criteria.

Testing Effect of the National Basic Newborn Resuscitation Educational Program on Midwives’ Knowledge and Skills: Observational Quasiexperimental Study

Background: Basic newborn resuscitation is a vital strategy to reduce the incidence of birth asphyxia and the associated outcomes. These outcomes can be improved if the midwives have the knowledge and skills of basic newborn resuscitation. Purpose: We assessed the midwives' knowledge and their quality of skills regarding BNR, as well as the effectiveness of an educational program in improving midwives' knowledge and skills during the process of BNR. Methods: A pretest-posttest design was conducted. The BNR educational program was adapted from the American Academy of Pediatrics (AAP) Neonatal Resuscitation Program (NRP). It was conducted through three days of workshops, including an overview lecture, interactive video modules, and extensive hands-on teaching of basic resuscitation techniques. Assessments (pre-and post-tests) were performed. Data was analyzed using ttest, one-way ANOVA, relative importance index analysis, and linear regression test. Results:100 midwives attended the workshops. Their mean scores were: knowledge score before the program (M=68.38%, SD= 13.4) and after the program (M=78.72%, SD=10.3), t=6.29, p&lt;0.001. The overall mean prioritization before the program was 2.71(out of 3) and after the program 2.9. The mean quality performance of skills (out of 4 points) before and after the educational program, respectively, were (M=2.2, SD=0.8) and (3.64, SD=0.5). According to multi-variant logistic regression, midwives’ age (years) and weekly to monthly practice of BNR correlated significantly and positively with higher odds of succeeding with a score &gt;= 84% on the knowledge test of post-educational program having been delivered to all the midwives. Conclusion: The study results showed the significant impact of the BNR educational program, followed immediately by the significant improvement in the midwives' knowledge and skills. Implications for Nursing: Midwives and neonatal nurses should be encouraged to upgrade their educational level to ensure their skill retention and expose themselves to BNR. Further, it is essential to understand the factors affecting how midwives and neonatal nurses gain and retain skills using a high-level methodology. Keywords: Basic newborn resuscitation (BNR), Midwives, Knowledge, Skills