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Halling C, Conroy S, Raymond T, Foglia EE, Haggerty M, Brown LL, Wyckoff MH. Use of Initial Endotracheal Versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room: Review of a National Database. J Pediatr 2024; 271:114058. [PMID: 38631614 DOI: 10.1016/j.jpeds.2024.114058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To assess whether initial epinephrine administration by endotracheal tube (ET) in newly born infants receiving chest compressions and epinephrine in the delivery room (DR) is associated with lower rates of return of spontaneous circulation (ROSC) than newborns receiving initial intravenous (IV) epinephrine. STUDY DESIGN We conducted a retrospective review of neonates receiving chest compressions and epinephrine in the DR from the AHA Get With The Guidelines-Resuscitation registry from October 2013 through July 2020. Neonates were classified according to initial route of epinephrine (ET vs IV). The primary outcome of interest was ROSC in the DR. RESULTS In total, 408 infants met inclusion criteria; of these, 281 (68.9%) received initial ET epinephrine and 127 (31.1%) received initial IV epinephrine. The initial ET epinephrine group included those infants who also received subsequent IV epinephrine when ET epinephrine failed to achieve ROSC. Comparing initial ET with initial IV epinephrine, ROSC was achieved in 70.1% vs 58.3% (adjusted risk difference 10.02; 95% CI 0.05-19.99). ROSC was achieved in 58.3% with IV epinephrine alone, and 47.0% with ET epinephrine alone, with 40.0% receiving subsequent IV epinephrine. CONCLUSIONS This study suggests that initial use of ET epinephrine is reasonable during DR resuscitation, as there were greater rates of ROSC compared with initial IV epinephrine administration. However, administration of IV epinephrine should not be delayed in those infants not responding to initial ET epinephrine, as almost one-half of infants who received initial ET epinephrine subsequently received IV epinephrine before achieving ROSC.
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Affiliation(s)
- Cecilie Halling
- Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH.
| | - Sara Conroy
- Center for Perinatal Research and the Ohio Perinatal Research Network, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH; Biostatistics Resource at Nationwide Children's Hospital, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Tia Raymond
- Department of Pediatrics, Cardiac Critical Care, Medical City Children's Hospital, Dallas, TX
| | - Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mary Haggerty
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Linda L Brown
- Department of Emergency Medicine, Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI; Department of Pediatrics, Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX
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Schmölzer GM, Pichler G, Solevåg AL, Law BHY, Mitra S, Wagner M, Pfurtscheller D, Yaskina M, Cheung PY. Sustained inflation and chest comp ression versus 3: 1 chest compression to ventilation ratio during cardiopulmonary resuscitation of asphyxiated n ewborns (SURV1VE): A cluster randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2024; 109:428-435. [PMID: 38212104 PMCID: PMC11228189 DOI: 10.1136/archdischild-2023-326383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/09/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE In newborn infants requiring chest compression (CC) in the delivery room (DR) does continuous CC superimposed by a sustained inflation (CC+SI) compared with a 3:1 compression:ventilation (3:1 C:V) ratio decreases time to return of spontaneous circulation (ROSC). DESIGN International, multicenter, prospective, cluster cross-over randomised trial. SETTING DR in four hospitals in Canada and Austria, PARTICIPANTS: Newborn infants >28 weeks' gestation who required CC. INTERVENTIONS Hospitals were randomised to CC+SI or 3:1 C:V then crossed over to the other intervention. MAIN OUTCOME MEASURE The primary outcome was time to ROSC, defined as the duration of CC until an increase in heart rate >60/min determined by auscultation of the heart, which was maintained for 60 s. Sample size of 218 infants (109/group) was sufficient to detect a clinically important 33% reduction (282 vs 420 s of CC) in time to ROSC. Analysis was intention-to-treat. RESULTS Patient recruitment occurred between 19 October 2017 and 22 September 2022 and randomised 27 infants (CC+SI (n=12), 3:1 C:V (n=15), two (one per group) declined consent). All 11 infants in the CC+SI group and 12/14 infants in the 3:1 C:V group achieved ROSC in the DR. The median (IQR) time to ROSC was 90 (60-270) s and 615 (174-780) s (p=0.0502 (log rank), p=0.16 (cox proportional hazards regression)) with CC+SI and 3:1 C:V, respectively. Mortality was 2/11 (18.2%) with CC+SI versus 8/14 (57.1%) with 3:1 C:V (p=0.10 (Fisher's exact test), OR (95% CI) 0.17; (0.03 to 1.07)). The trial was stopped due to issues with ethics approval and securing trial insurance as well as funding reasons. CONCLUSION The time to ROSC and mortality was not statistical different between CC+SI and 3:1 C:V. TRIAL REGISTRATION NCT02858583.
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Affiliation(s)
- Georg M Schmölzer
- Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Anne Lee Solevåg
- The Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Brenda Hiu Yan Law
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Souvik Mitra
- Departments of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Wagner
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Pediatric Neurology, Medical University Vienna, Vienna, Austria
| | | | - Maryna Yaskina
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Po-Yin Cheung
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Lin H, Han J, Jiang P, Yu Z, Zhou P, Tang H, Ding L, Liu J. Neonatal Resuscitation Online Registry in Shenzhen: protocol for a prospective, multicentre, open, observational cohort study. BMJ Open 2024; 14:e081670. [PMID: 38858150 PMCID: PMC11168126 DOI: 10.1136/bmjopen-2023-081670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/10/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION Preterm birth complications and neonatal asphyxia are the leading causes of neonatal mortality worldwide. Surviving preterm and asphyxiated newborns can develop neurological sequelae; therefore, timely and appropriate neonatal resuscitation is important to decrease neonatal mortality and disability rates. There are very few systematic studies on neonatal resuscitation in China, and its prognosis remains unclear. We established an online registry for neonatal resuscitation in Shenzhen based on Utstein's model and designed a prospective, multicentre, open, observational cohort study to address many of the limitations of existing studies. The aim of this study is to explore the implementation and management, risk factors and outcomes of neonatal resuscitation in Shenzhen. METHODS AND ANALYSIS This prospective, multicentre, open, observational cohort study will be conducted between January 2024 and December 2026 and will include >1500 newborns resuscitated at birth by positive pressure ventilation at five hospitals in Shenzhen, located in the south-central coastal area of Guangdong province, China. Maternal and infant information, resuscitation information, hospitalisation information and follow-up information will be collected. Maternal and infant information, resuscitation information and hospitalisation information will be collected from the clinical records of the patients. Follow-up information will include the results of follow-up examinations and outcomes, which will be recorded using the WeChat applet 'Resuscitation Follow-up'. These data will be provided by the neonatal guardians through the applet on their mobile phones. This study will provide a more comprehensive understanding of the implementation and management, risk factors and outcomes of neonatal resuscitation in Shenzhen; the findings will ultimately contribute to the reduction of neonatal mortality and disability rates in Shenzhen. ETHICS AND DISSEMINATION Our protocol has been approved by the Medical Ethics Committee of Shenzhen Luohu People's Hospital (2023-LHQRMYY-KYLL-048). We will present the study results at academic conferences and peer-reviewed paediatrics journals. TRIAL REGISTRATION NUMBER ChiCTR2300077368.
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Affiliation(s)
- Hanni Lin
- Neonatology, Shenzhen Luohu People's Hospital, Shenzhen, Guangdong, China
| | - Jing Han
- Neonatal Intensive Care Unit, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, Guangdong, China
| | - Ping Jiang
- Neonatology, Shenzhen Luohu People's Hospital, Shenzhen, Guangdong, China
| | - Zhangbin Yu
- Neonatology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Ping Zhou
- Neonatology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, Guangdong, China
| | - Hong Tang
- Neonatology, Shenzhen Yantian District People's Hospital (Group), Shenzhen, Guangdong, China
| | - Lu Ding
- Neonatology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Jiebo Liu
- Neonatology, Shenzhen Luohu People's Hospital, Shenzhen, Guangdong, China
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Liley HG, Haakons K. Restarting the newborn infant heart. Resuscitation 2024; 199:110237. [PMID: 38740252 DOI: 10.1016/j.resuscitation.2024.110237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Helen G Liley
- Mater Research, Faculty of Medicine, The University of Queensland, Australia.
| | - Kristen Haakons
- Mater Research, Faculty of Medicine, The University of Queensland, Australia
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Vali P, Chen P, Giusto E, Lesneski A, Hardie ME, Knych HK, Sankaran D, Alhassen Z, Joudi HM, Lakshminrusimha S. Direct Umbilical Vein Injection of Epinephrine with Cut-Cord Milking in an Ovine Model of Neonatal Resuscitation. CHILDREN (BASEL, SWITZERLAND) 2024; 11:527. [PMID: 38790522 PMCID: PMC11120376 DOI: 10.3390/children11050527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND An umbilical venous catheter (UVC) is the preferred route of epinephrine administration during neonatal resuscitation but requires specialized equipment, expertise, and time. HYPOTHESIS Direct injection of epinephrine into the umbilical vein (UV) followed by milking a ~20 cm segment of cut umbilical cord to flush the epinephrine (DUV + UCM) will lead to a quicker administration and earlier return of spontaneous circulation (ROSC) compared with epinephrine given through a UVC. DESIGN Eighteen near-term asphyxiated lambs were randomized to receive a low-UVC or DUV + UCM of epinephrine at 0.02 or 0.03 mg/kg doses. OUTCOME MEASURES A total of 16/18 lambs achieved ROSC with a similar mean (±SEM) time to ROSC [DUV + UCM vs. low-UVC (4.67 ± 0.67 vs. 3.99 ± 0.58 min); p = 0.46]. Two out of ten lambs in the DUV + UCM group required UVC placement for additional epinephrine. The administration of the first dose of epinephrine was similar (DUV + UCM-2.97 ± 0.48 vs. UVC-4.23 ± 0.58 min; p = 0.12). Both methods yielded similar epinephrine concentrations (peak concentrations of 253 ± 63 and 328 ± 80 ng/mL for DUV + UCM and UVC EPI, respectively). CONCLUSIONS DUV + UCM resulted in a ROSC success of 78% following the first epinephrine dose and showed similar epinephrine concentrations to UVC. Clinical studies evaluating DUV + UCM as an alternate route for epinephrine while intravenous access is being established are warranted.
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Affiliation(s)
- Payam Vali
- Division of Neonatology, Department of Pediatrics, University of California Davis, Sacramento, CA 95817, USA; (P.V.); (D.S.); (H.M.J.)
| | - Peggy Chen
- Division of Neonatology, Miller Children’s & Women’s Hospital Long Beach, Long Beach, CA 90806, USA;
| | - Evan Giusto
- Division of Neonatology, Department of Pediatrics, University of California Davis, Sacramento, CA 95817, USA; (P.V.); (D.S.); (H.M.J.)
- D-5 Neonatal Units, Patient Care Services, University of California Davis, Sacramento, CA 95817, USA
| | - Amy Lesneski
- Department of Stem Cell Research, University of California Davis, Sacramento, CA 95817, USA
| | - Morgan E. Hardie
- School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA
| | - Heather K. Knych
- K.L. Maddy Equine Analytical Pharmacology Laboratory, Department of Veterinary Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA
| | - Deepika Sankaran
- Division of Neonatology, Department of Pediatrics, University of California Davis, Sacramento, CA 95817, USA; (P.V.); (D.S.); (H.M.J.)
| | - Ziad Alhassen
- Division of Neonatology, Children’s Hospital of Orange County, Orange, CA 92868, USA
| | - Houssam M. Joudi
- Division of Neonatology, Department of Pediatrics, University of California Davis, Sacramento, CA 95817, USA; (P.V.); (D.S.); (H.M.J.)
| | - Satyan Lakshminrusimha
- Division of Neonatology, Department of Pediatrics, University of California Davis, Sacramento, CA 95817, USA; (P.V.); (D.S.); (H.M.J.)
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O'Reilly M, Lee TF, Cheung PY, Schmölzer GM. Vasopressin versus epinephrine during neonatal cardiopulmonary resuscitation of asphyxiated post-transitional piglets. Resusc Plus 2023; 15:100427. [PMID: 37519409 PMCID: PMC10372457 DOI: 10.1016/j.resplu.2023.100427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/17/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Background Epinephrine is currently the only recommended cardio-resuscitative medication for use in neonatal cardiopulmonary resuscitation (CPR), as per the consensus of science and treatment recommendations. An alternative medication, vasopressin, might be beneficial in neonatal CPR due to its combined pulmonary vasodilation and systemic vasoconstriction properties. Aim We aimed to compare the time to return of spontaneous circulation (ROSC) with administration of vasopressin or epinephrine during CPR of asphyxiated post-transitional piglets. Methods Newborn piglets (n = 8/group) were anesthetized, tracheotomized and intubated, instrumented, and exposed to 50 min normocapnic hypoxia followed by asphyxia and cardiac arrest. Piglets were randomly allocated to receive vasopressin (Vaso, 0.4 U/kg) or epinephrine (Epi, 0.02 mg/kg) during CPR. Piglets were resuscitated with chest compressions superimposed with sustained inflations, and were administered either Vaso or Epi intravenously every 3 min until ROSC (max. 3 doses). Hemodynamic and cardiac function parameters were collected. Main Results The median (IQR) time to ROSC was 106 (93-140) s with Vaso and 128 (100-198) s with Epi (p = 0.28). The number of piglets that achieved ROSC was 8 (100%) with Vaso and 7 (88%) with Epi (p = 1.00). Vaso-treated piglets had a significantly longer post-resuscitation survival time (240 (240-240) min) than Epi-treated piglets (65 (30-240) min, p = 0.02). Vaso-treated piglets had significantly improved carotid blood flow immediately after ROSC (p < 0.05), had longer duration of post-resuscitation hypertension (p = 0.05), and had significantly improved heart rate, arterial pressure, and cerebral blood oxygen saturation 4 h after ROSC (p < 0.05). Conclusions Vasopressin improved post-resuscitation survival and hemodynamics, and might be an alternative cardio-resuscitative medication during neonatal CPR, but further studies are warranted.
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Affiliation(s)
| | | | | | - Georg M. Schmölzer
- Corresponding author at: Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, T5H 3V9, Edmonton, Alberta, Canada.
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Physiology of neonatal resuscitation: Giant strides with small breaths. Semin Perinatol 2022; 46:151620. [PMID: 35715254 DOI: 10.1016/j.semperi.2022.151620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The transition of a fetus to a newborn involves a sequence of well-orchestrated physiological events. Most neonates go through this transition without assistance but 5-10% may require varying degrees of resuscitative interventions at birth. The most crucial event during this transition is lung inflation with optimal concentrations of oxygen. Rarely, extensive resuscitation including chest compressions and medication may be required. In the past few decades, significant strides have been made in our understanding of the cardiorespiratory transition at birth from a fetus to a newborn and the subsequent resuscitation. This article reviews the physiology behind neonatal transition at birth and various interventions during neonatal resuscitation.
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Abstract
The goal of neonatal bioethics is to help clinicians navigate difficult decisions that arise every day in the care of critically ill newborns. Over the last few decades, there have been vigorous discussions of numerous ethical issues. For some, we have worked out a tentative societal agreement for appropriate responses. Others remain contentious and controversial. They evoke moral distress. In this article, we address some of these unresolved issues including the changing landscape of duration and viability threshold for newborn resuscitation, the issue of borderline of viability and the ethical controversies that arise when each center has its own policies, and some of the challenges that arise in Fetal Care Centers (FCC). Finally, we propose a generalizable model of shared decision making.
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Affiliation(s)
- Becky J Ennis
- Neonatologist, Associate Professor of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center
| | - Danielle Jw Reed
- Neonatologist, Associate Professor of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Mercy Hospital-Kansas City, University of Missouri-Kansas City School of Medicine.
| | - John D Lantos
- Director of the Children's Mercy Bioethics Center, Professor of Pediatrics, Department of Pediatrics, Children's Mercy Hospital-Kansas City, University of Missouri-Kansas City School of Medicine
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Oh TK, Choi CW, Song IA. Epidemiologic study of in-hospital cardiopulmonary resuscitation among pediatric patients: A retrospective, population-based cohort study in South Korea. Medicine (Baltimore) 2022; 101:e30445. [PMID: 36086791 PMCID: PMC10980375 DOI: 10.1097/md.0000000000030445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
We aimed to examine the clinical trends of in-hospital cardiopulmonary resuscitation (ICPR) and factors associated with live discharge following ICPR. As a national population-based cohort study, data were extracted from the South Korean National Inpatient Database. This study included 8992 pediatric patients under 18 years of age who underwent ICPR due to in-hospital cardiac arrest during hospitalization in South Korea between 2010 and 2019 (10 years). The annual prevalence, survival, duration of hospitalization, and total cost of hospitalization at ICPR were examined as clinical trends. In 2010, 7.94 per 100,000 pediatric patients received ICPR; the prevalence increased to 11.51 per 100,000 pediatric patients in 2019. The 10-year survival rates were similar, and the in-hospital, 6-month, and 1-year survival rates over 10 years were 44.0%, 34.0%, and 32.4%, respectively. The mean length of hospital stay at ICPR in 2010 was 20.7 (95% confidence interval [CI]: 19.3-22.2) days; this decreased to 16.6 (95% CI: 15.2-18.0) days in 2019. The mean total cost at ICPR was 11,081.1 (95% CI: 10,216.2-11,946.1) United States Dollars (USD) in 2010; this increased to 22,629.4 (95% CI: 20,588.3-24,670.5) USD in 2019. The prevalence of ICPR increased among pediatric patients in South Korea between 2010 and 2019; however, the survival rates were similar for the 10 years. The length of hospital stay at ICPR gradually decreased from 2010 through 2019, while the total cost of hospitalization at ICPR has gradually increased between 2010 and 2019.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Wenn die Maskenbeatmung beim Neugeborenen schwierig ist. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungDie entscheidende und zumeist einzig notwendige Maßnahme für die erfolgreiche Reanimation eines Neugeborenen nach der Geburt ist die effektive Ventilation der Lunge [1]. Bereits eine kurze Maskenbeatmung führt, bei einem zunächst nicht oder nicht suffizient spontan atmenden Neugeborenen, in den meisten Fällen zum Einsetzen einer effektiven Eigenatmung und damit zu einer raschen klinischen Stabilisierung. In den meisten Fällen gelingt eine Maskenbeatmung problemlos, allerdings bereitet sie immer wieder auch Schwierigkeiten.In Kursen, die sich mit der Versorgung des kritisch kranken Neugeborenen befassen (u. a. die Newborn-Life-Support-Kurse des Austrian Resuscitation Council (ARC), des German Resuscitation Council (GRC) und der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI)) [2], liegt daher ein Schwerpunkt auf Maßnahmen zur Optimierung einer nichtinvasiven Beatmung, die häufig nur unzureichend bekannt sind.Dieser Artikel widmet sich Strategien, wie eine nichtinvasive Beatmung beim Neugeborenen optimiert werden kann, und schlägt mit dem deutschsprachigen Akronym „RALPH“ eine Möglichkeit vor, wie Schwierigkeiten bei der Maskenbeatmung strukturiert und zielgerichtet überwunden werden können.
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Mani S, Pinheiro JMB, Rawat M. Laryngeal Masks in Neonatal Resuscitation-A Narrative Review of Updates 2022. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050733. [PMID: 35626910 PMCID: PMC9139380 DOI: 10.3390/children9050733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022]
Abstract
Positive pressure ventilation (PPV) is crucial to neonatal cardiopulmonary resuscitation because respiratory failure precedes cardiac failure in newborns affected by perinatal asphyxia. Prolonged ineffective PPV could lead to a need for advanced resuscitation such as intubation, chest compression, and epinephrine. Every 30 s delay in initiation of PPV increased the risk of death or morbidity by 16%. The most effective interface for providing PPV in the early phases of resuscitation is still unclear. Laryngeal masks (LMs) are supraglottic airway devices that provide less invasive and relatively stable airway access without the need for laryngoscopy which have been studied as an alternative to face masks and endotracheal tubes in the initial stages of neonatal resuscitation. A meta-analysis found that LM is a safe and more effective alternative to face mask ventilation in neonatal resuscitation. LM is recommended as an alternative secondary airway device for the resuscitation of infants > 34 weeks by the International Liaison Committee on Resuscitation. It is adopted by various national neonatal resuscitation guidelines across the globe. Recent good-quality randomized trials have enhanced our understanding of the utility of laryngeal masks in low-resource settings. Nevertheless, LM is underutilized due to its variable availability in delivery rooms, providers’ limited experience, insufficient training, preference for endotracheal tube, and lack of awareness.
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Affiliation(s)
- Srinivasan Mani
- Pediatrics, University of Toledo, Toledo, OH 43606, USA
- Correspondence:
| | | | - Munmun Rawat
- Pediatrics, University at Buffalo, Buffalo, NY 14260, USA;
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McPherson C. Know the Code: Medications for Resuscitation in Neonates. Neonatal Netw 2022; 41:107-113. [PMID: 35260428 DOI: 10.1891/nn-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Resuscitations in the delivery room or the nursery cause significant stress for caregivers. Diligent preparation will improve the efficacy and safety of life-saving interventions and increase staff comfort. When establishment of an airway and delivery of positive pressure ventilation and chest compressions fail to result in return of spontaneous circulation, pharmacotherapeutic interventions should be considered. Epinephrine is first-line pharmacotherapy for severe bradycardia or cardiac arrest, increasing coronary arterial pressure and blood flow during chest compressions. Despite limited data regarding dosing and efficacy, the first dose of epinephrine may be delivered through the endotracheal tube during attainment of venous access (preferably a low-lying umbilical venous catheter in the delivery room). Intravenous dosing is preferred, and any facility caring for newborns must ensure optimized logistics including readily available dosing guidance and optimal flush volumes. After provision of epinephrine, additional medications may be considered, especially for resuscitations occurring outside of the immediate perinatal period, including normal saline, glucose, adenosine, atropine, and calcium. Clinicians must understand the indications, dosing, and monitoring parameters for these medications and ensure rapid availability for resuscitation. Every second truly counts in a neonatal resuscitation, and optimal understanding and preparation will ensure delivery of pharmacotherapy to optimize both patient outcomes and staff comfort.
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Resuscitation highlights in 2021. Resuscitation 2022; 172:64-73. [PMID: 35077856 DOI: 10.1016/j.resuscitation.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND This review is the latest in a series of regular annual reviews undertaken by the editors and aims to highlight some of the key papers published in Resuscitation during 2021. METHODS Hand-searching by the editors of all papers published in Resuscitation during 2021. Papers were selected based on then general interest and novelty and were categorised into themes. RESULTS 98 papers were selected for brief mention. CONCLUSIONS Resuscitation science continues to evolve and incorporates all links in the chain of survival.
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Handley SC, Passarella M, Raymond TT, Lorch SA, Ades A, Foglia EE. Epidemiology and outcomes of infants after cardiopulmonary resuscitation in the neonatal or pediatric intensive care unit from a national registry. Resuscitation 2021; 165:14-22. [PMID: 34107334 PMCID: PMC8324549 DOI: 10.1016/j.resuscitation.2021.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/12/2021] [Accepted: 05/28/2021] [Indexed: 12/01/2022]
Abstract
AIM Cardiopulmonary resuscitation (CPR) in hospitalized infants is a relatively uncommon but high-risk event associated with mortality. The study objective was to identify factors associated with mortality and survival among infants who receive CPR in the neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU). METHODS Retrospective observational study of infants with an index CPR event in the NICU or PICU between 1/1/06 and 12/31/18 in the American Heart Association's Get With The Guidelines-Resuscitation registry. Associations between patient, event, unit, and hospital factors and the primary outcome, mortality prior to discharge, were examined using multivariable logistic regression. RESULTS Among 3521 infants who received CPR, 2080 (59%) died before discharge, with 25% mortality during CPR and 40% within 24 h. Mortality prior to discharge occurred in 65% and 47% of cases in the NICU and PICU, respectively. Factors most strongly independently associated with pre-discharge mortality were vasoactive agent before CPR (adjusted odds ratio (aOR): 2.77, 95% confidence interval (CI) 2.15-3.58), initial pulseless condition (aOR: 2.38, 95% CI 1.46-3.86) or development of pulselessness (aOR: 2.36, 95% CI 1.78-3.12), and NICU location compared with PICU (aOR: 3.85, 95% CI 2.86-5.19). Endotracheal intubation during CPR was associated with decreased odds of pre-discharge mortality (aOR: 0.40, 95% CI 0.33-0.49). CONCLUSION Infants who receive CPR in the intensive care unit experience high mortality rates; identifiable patient, event, and unit factors increase the odds of mortality. Further investigation should explore the association between unit type, resuscitation processes, and mortality.
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Affiliation(s)
- Sara C Handley
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk #210, Philadelphia, PA 19104, United States.
| | - Molly Passarella
- Center for Perinatal and Pediatric Health Disparities Research, The Children's Hospital of Philadelphia, 2716 South Street 19th Floor, Philadelphia, PA 19146, United States
| | - Tia T Raymond
- Department of Pediatrics, Division of Cardiac Critical Care, Medical City Children's Hospital, 7777 Forest Lane Suite C-300J, Dallas, TX 75230, United States
| | - Scott A Lorch
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk #210, Philadelphia, PA 19104, United States; Center for Perinatal and Pediatric Health Disparities Research, The Children's Hospital of Philadelphia, 2716 South Street 19th Floor, Philadelphia, PA 19146, United States
| | - Anne Ades
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States
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Vali P, Weiner GM, Sankaran D, Lakshminrusimha S. What is the optimal initial dose of epinephrine during neonatal resuscitation in the delivery room? J Perinatol 2021; 41:1769-1773. [PMID: 33712718 DOI: 10.1038/s41372-021-01032-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/29/2021] [Accepted: 02/25/2021] [Indexed: 01/25/2023]
Abstract
The neonatal resuscitation program recommends a wide dose range of epinephrine for newborns who receive chest compressions (endotracheal tube [ET] dose of 0.05-0.1 mg/kg or intravenous [IV] dose of 0.01-0.03 mg/kg), which presents a challenge to neonatal care providers when attempting to determine the optimal initial dose. Dosing errors are common when preparing epinephrine for neonatal resuscitation. Based on animal data, we suggest preparing 0.1 mg/kg or 1 ml/kg of 1 mg/10 ml epinephrine in a 5 ml syringe for ET administration. For IV epinephrine, we suggest preparing an initial dose of 0.02 mg/kg or 0.2 ml/kg of 1 mg/10 ml epinephrine in a 1 ml syringe. A dose of 0.02 mg/kg enables use of a 1 ml syringe for a wide range of birth weights from 500 g to 5 kg. The use of a color-coded syringe may decrease errors in dose preparation.
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Affiliation(s)
- Payam Vali
- Department of Pediatrics, University of California, Davis, Sacramento, CA, USA.
| | - Gary M Weiner
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Deepika Sankaran
- Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
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钱 苗, 余 章, 陈 小, 徐 艳, 马 月, 姜 善, 王 淮, 王 增, 韩 良, 李 双, 卢 红, 万 俊, 高 艳, 陈 筱, 赵 莉, 吴 明, 张 红, 薛 梅, 朱 玲, 田 兆, 屠 文, 吴 新, 韩 树, 顾 筱. [Clinical features of preterm infants with a birth weight less than 1 500 g undergoing different intensities of resuscitation: a multicenter retrospective analysis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:593-598. [PMID: 34130781 PMCID: PMC8214002 DOI: 10.7499/j.issn.1008-8830.2101142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the clinical features of preterm infants with a birth weight less than 1 500 g undergoing different intensities of resuscitation. METHODS A retrospective analysis was performed for the preterm infants with a birth weight less than 1 500 g and a gestational age less than 32 weeks who were treated in the neonatal intensive care unit of 20 hospitals in Jiangsu, China from January 2018 to December 2019. According to the intensity of resuscitation in the delivery room, the infants were divided into three groups:non-tracheal intubation (n=1 184), tracheal intubation (n=166), and extensive cardiopulmonary resuscitation (ECPR; n=116). The three groups were compared in terms of general information and clinical outcomes. RESULTS Compared with the non-tracheal intubation group, the tracheal intubation and ECPR groups had significantly lower rates of cesarean section and use of antenatal corticosteroid (P < 0.05). As the intensity of resuscitation increased, the Apgar scores at 1 minute and 5 minutes gradually decreased (P < 0.05), and the proportion of infants with Apgar scores of 0 to 3 at 1 minute and 5 minutes gradually increased (P < 0.05). Compared with the non-tracheal intubation group, the tracheal intubation and ECPR groups had significantly higher mortality rate and incidence rates of moderate-severe bronchopulmonary dysplasia and serious complications (P < 0.05). The incidence rates of grade Ⅲ-Ⅳ intracranial hemorrhage and retinopathy of prematurity (stage Ⅲ or above) in the tracheal intubation group were significantly higher than those in the non-tracheal intubation group (P < 0.05). CONCLUSIONS For preterm infants with a birth weight less than 1 500 g, the higher intensity of resuscitation in the delivery room is related to lower rate of antenatal corticosteroid therapy, lower gestational age, and lower birth weight. The infants undergoing tracheal intubation or ECRP in the delivery room have an increased incidence rate of adverse clinical outcomes. This suggests that it is important to improve the quality of perinatal management and delivery room resuscitation to improve the prognosis of the infants.
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Affiliation(s)
- 苗 钱
- 南京医科大学附属妇产医院/南京市妇幼保健院新生儿科, 江苏南京 210004Department of Neonatology, Women's Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
| | - 章斌 余
- 南京医科大学附属妇产医院/南京市妇幼保健院新生儿科, 江苏南京 210004Department of Neonatology, Women's Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
| | - 小慧 陈
- 南京医科大学附属妇产医院/南京市妇幼保健院新生儿科, 江苏南京 210004Department of Neonatology, Women's Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
| | - 艳 徐
- 徐州医科大学附属医院新生儿科, 江苏徐州 221002
| | - 月兰 马
- 南京医科大学附属苏州医院/苏州市立医院新生儿科, 江苏苏州 215002
| | - 善雨 姜
- 无锡市妇幼保健院新生儿科, 江苏无锡 214002
| | - 淮燕 王
- 常州市妇幼保健院新生儿科, 江苏常州 213003
| | - 增芹 王
- 徐州市妇幼保健院新生儿科, 江苏徐州 221009
| | - 良荣 韩
- 淮安市妇幼保健院新生儿科, 江苏淮安 223002
| | - 双双 李
- 南通市妇幼保健院新生儿科, 江苏南通 226001
| | - 红艳 卢
- 江苏大学附属医院新生儿科, 江苏镇江 212001
| | | | - 艳 高
- 连云港市妇幼保健院新生儿科, 江苏连云港 222000
| | - 筱青 陈
- 南京医科大学第一附属医院新生儿科, 江苏南京 210036
| | - 莉 赵
- 南京医科大学附属儿童医院新生儿科, 江苏南京 210008
| | - 明赴 吴
- 扬州大学附属医院新生儿科, 江苏扬州 225001
| | | | | | | | - 兆方 田
- 淮安市第一人民医院新生儿科, 江苏淮安 223002
| | | | - 新萍 吴
- 扬州市妇幼保健院新生儿科, 江苏扬州 225002
| | - 树萍 韩
- 南京医科大学附属妇产医院/南京市妇幼保健院新生儿科, 江苏南京 210004Department of Neonatology, Women's Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
| | - 筱琪 顾
- 南京医科大学附属妇产医院/南京市妇幼保健院新生儿科, 江苏南京 210004Department of Neonatology, Women's Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
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Sawyer T. Neonatal resuscitation: Airway, Breathing, and then Chest compressions. Resuscitation 2020; 158:275-276. [PMID: 33181228 DOI: 10.1016/j.resuscitation.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/02/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Taylor Sawyer
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, United States.
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