Remember fatigue during neonatal cardiopulmonary resuscitation and don't forget to change resuscitators

Effect of rotating providers on chest compression performance during simulated neonatal cardiopulmonary resuscitation

Objective

Simulation studies in adults and pediatrics demonstrate improvement in chest compression (CCs) quality as providers rotate every two minutes. There is paucity of studies in neonates on this matter. This study hypothesized that frequent rotation while performing CCs improves provider performance and decreases fatigue.

Study design

Prospective randomized, observational crossover study where 51 providers performed 3:1 compression-ventilation CPR as a pair on a term manikin. Participants performed CCs as part of 3 simulation models, rotating every 3, 5 and 10 minutes. Data on various CC metrics were collected. Participant vitals were recorded at multiple points during the simulation and participants reported their level of fatigue at completion of simulation.

Results

No statistically significant difference was seen in any of the compression metrics. However, differences in the providers’ fatigue scores were statistically significant.

Conclusion

CC performance metrics did not differ significantly, however, providers’ vital signs and self-reported fatigue scores significantly increased with longer CC durations.

Rescuer Exertion and Fatigue Using Two-Thumb vs. Two-Finger Method During Simulated Neonatal Cardiopulmonary Resuscitation

Background: Rescuer fatigue during neonatal CPR can affect CPR quality leading to reduced cerebral and myocardial perfusion. Aim: To investigate rescuer fatigue during simulated neonatal CPR using both objective (heart rate and cardiac output) and subjective measures. Methods: A randomized crossover manikin study performed. Nineteen doctors working in neonatology were randomized to (a) two-thumb term, (b) two-finger term, (c) two-thumb preterm, or (d) two-finger preterm group. Cardiac output and heart rate were measured with a non-invasive cardiac output monitor. A Likert scale assessed participants' level of perceived exertion. Results: In the preterm group, the mean change in HR from rest to 5 min in the TT group was 11.58 bpm (SD 6.22) vs. 9.94 bpm (SD 8.48), (p-value 0.36). There was no difference in change in CO, 2.10 (SD 1.15) in the TT group vs. 1.39 (SD 1.63) in TF group (p value 0.23). There was no difference in BORG RPE rating. In the term group, the mean change in HR from rest to 5 min was 15 bpm (SD 8.40) in TT group and 13 bpm (SD 7.86) in TF group, (p-value 0.416). The median change in CO from rest to 5 min was 1.50 (0.78 to 2.42 IQR) in TT group vs. 1.60 (0.65 to 3.0 IQR) in TF group. Conclusion: Providing chest compressions is associated with an increase in both heart rate and cardiac output. We did not identify difference between objective and subjective measures of fatigue between either technique in a preterm or term model.

Corrective ventilation strategies in delivery room resuscitation of preterm infants

AIM

Corrective ventilation strategies (CVS) during neonatal resuscitation and stabilisation (R&S) are taught through the MRSOPA mnemonic: Mask adjustment, Repositioning airway, Suctioning, Opening the mouth, Increasing inspiratory Pressure, and Alternative airway. The aim was to examine the use of CVS and to investigate the relationship between MRSOPA strategies and intubation of very preterm infants <32 weeks' gestation in the delivery room.

METHODS

Retrospective review of video recordings of R&S of preterm infants born in Cork University Maternity Hospital, Ireland.

RESULTS

In 46 resuscitation recordings, mask adjustment was observed in almost all (95.6%), followed by suctioning, (23.9%), opening the mouth (100%), increasing inspiratory pressure (81.0%) and intubation (32.6%). The most frequently used mask holds were: one-handed (95.6%), two-handed (63.0%), stem hold (23.8%), and modified spider hold (6.5%). There were no significant associations between individual mask holds and intubation. The more CVS employed the greater the need for intubation.

CONCLUSION

The greater the number of MRSOPA strategies used in the delivery room, the more likely intubation occurred. Further studies may identify the effect of these CVS on short- and long-term outcomes, in order to enhance R&S training and clinical practice.