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Pike H, Kolstad V, Eilevstjønn J, Davis PG, Ersdal HL, Rettedal S. Newborn resuscitation timelines: Accurately capturing treatment in the delivery room. Resuscitation 2024; 197:110156. [PMID: 38417611 DOI: 10.1016/j.resuscitation.2024.110156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVES To evaluate the use of newborn resuscitation timelines to assess the incidence, sequence, timing, duration of and response to resuscitative interventions. METHODS A population-based observational study conducted June 2019-November 2021 at Stavanger University Hospital, Norway. Parents consented to participation antenatally. Newborns ≥28 weeks' gestation receiving positive pressure ventilation (PPV) at birth were enrolled. Time of birth was registered. Dry-electrode electrocardiogram was applied as soon as possible after birth and used to measure heart rate continuously during resuscitation. Newborn resuscitation timelines were generated from analysis of video recordings. RESULTS Of 7466 newborns ≥28 weeks' gestation, 289 (3.9%) received PPV. Of these, 182 had the resuscitation captured on video, and were included. Two-thirds were apnoeic, and one-third were breathing ineffectively at the commencement of PPV. PPV was started at median (quartiles) 72 (44, 141) seconds after birth and continued for 135 (68, 236) seconds. The ventilation fraction, defined as the proportion of time from first to last inflation during which PPV was provided, was 85%. Interruption in ventilation was most frequently caused by mask repositioning and auscultation. Suctioning was performed in 35% of newborns, in 95% of cases after the initiation of PPV. PPV was commenced within 60 s of birth in 49% of apnoeic and 12% of ineffectively breathing newborns, respectively. CONCLUSIONS Newborn resuscitation timelines can graphically present accurate, time-sensitive and complex data from resuscitations synchronised in time. Timelines can be used to enhance understanding of resuscitation events in data-guided quality improvement initiatives.
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Affiliation(s)
- Hanne Pike
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Vilde Kolstad
- Department for Simulation-based Learning, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Hege Langli Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; Department for Simulation-based Learning, Stavanger University Hospital, Stavanger, Norway
| | - Siren Rettedal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; Department for Simulation-based Learning, Stavanger University Hospital, Stavanger, Norway.
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, Fernanda de Almeida M, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Daripa Kawakami M, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, John Madar R, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Gene Ong YK, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2024; 195:109992. [PMID: 37937881 DOI: 10.1016/j.resuscitation.2023.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Almeida MF, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Ong YKG, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2023; 148:e187-e280. [PMID: 37942682 PMCID: PMC10713008 DOI: 10.1161/cir.0000000000001179] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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Rettedal S, Kibsgaard A, Kvaløy JT, Eilevstjønn J, Ersdal HL. Prevalence of bradycardia in 4876 newborns in the first minute after birth and association with positive pressure ventilation: a population-based cross-sectional study. Arch Dis Child Fetal Neonatal Ed 2023:fetalneonatal-2023-325878. [PMID: 37940377 DOI: 10.1136/archdischild-2023-325878] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/28/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To determine the prevalence of bradycardia in the first minute after birth and association with positive pressure ventilation (PPV). METHOD A population-based cross-sectional study was conducted from June 2019 to December 2021 at Stavanger University Hospital, Norway. Parents consented to participation during pregnancy, and newborns ≥28 weeks' gestation were included at birth. Heart rate (HR) was captured immediately after birth and continuously for the first minute(s). Time of birth was registered on a tablet. Provision of PPV was captured using video. RESULTS Of 4876 included newborns, 164 (3.4%) did not breathe (two-thirds) or breathed ineffectively (one-third) and received PPV at birth. HR in the first minute had a wide distribution. The prevalence of first measured HR <100 and <60 beats/minute at median 16 s was 16.3% and 0.6%, respectively. HR increased in most cases. At 60 s, 3.7% had HR <100 beats/minute, of which 82% did not require PPV. In total, 25% of newborns had some registered HR <100 beats/minute during the first minute, of which 95% did not require PPV. Among newborns who received PPV, 76% and 62% had HR ≥100 beats/minute at 60 s and at start PPV, respectively. CONCLUSION Bradycardia with HR <100 bpm in the first minute of life was frequent, but mostly self-resolved. Among the 4% of newborns that remained bradycardic at 60 s, only 20% received PPV. Two-thirds of resuscitated newborns had HR ≥100 beats/minute at start PPV. None of the ventilated newborns were breathing adequately at start PPV. TRIAL REGISTRATION NUMBER NCT03849781.
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Affiliation(s)
- Siren Rettedal
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Amalie Kibsgaard
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Jan Terje Kvaløy
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - Joar Eilevstjønn
- Strategic Research, Laerdal Medical AS, Stavanger, Rogaland, Norway
| | - Hege Langli Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway
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Schneider MS, Sandve KO, Kurz KD, Dalen I, Ospel J, Goyal M, Kurz MW, Fjetland L. Metric based virtual simulation training for endovascular thrombectomy improves interventional neuroradiologists' simulator performance. Interv Neuroradiol 2023; 29:577-582. [PMID: 35832034 PMCID: PMC10549713 DOI: 10.1177/15910199221113902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Metric based virtual reality simulation training may enhance the capability of interventional neuroradiologists (INR) to perform endovascular thrombectomy. As pilot for a national simulation study we examined the feasibility and utility of simulated endovascular thrombectomy procedures on a virtual reality (VR) simulator. METHODS Six INR and four residents participated in the thrombectomy skill training on a VR simulator (Mentice VIST 5G). Two different case-scenarios were defined as benchmark-cases, performed before and after VR simulator training. INR performing endovascular thrombectomy clinically were also asked to fill out a questionnaire analyzing their degree of expectation and general attitude towards VR simulator training. RESULTS All participants improved in mean total procedure time for both benchmark-cases. Experts showed significant improvements in handling errors (case 2), a reduction in contrast volume used (case 1 and 2), and fluoroscopy time (case 1 and 2). Novices showed a significant improvement in steps finished (case 2), a reduction in fluoroscopy time (case 1), and radiation used (case 1). Both, before and after having performed simulation training the participating INR had a positive attitude towards VR simulation training. CONCLUSION VR simulation training enhances the capability of INR to perform endovascular thrombectomy on the VR simulator. INR have generally a positive attitude towards VR simulation training. Whether the VR simulation training translates to enhanced clinical performance will be evaluated in the ongoing Norwegian national simulation study.
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Affiliation(s)
- Magnus Sundgot Schneider
- Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Knut Olav Sandve
- Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Kathinka Dæhli Kurz
- Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway
- Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Johanna Ospel
- Department of Radiology, Basel University Hospital, Basel, Switzerland
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
| | - Martin W Kurz
- Department of Neurology, Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Norway
| | - Lars Fjetland
- Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Norway
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Kolstad V, Pike H, Eilevstjønn J, Buskov F, Ersdal H, Rettedal S. Use of Pulse Oximetry during Resuscitation of 230 Newborns-A Video Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1124. [PMID: 37508621 PMCID: PMC10377843 DOI: 10.3390/children10071124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND European guidelines recommend the use of pulse oximetry (PO) during newborn resuscitation, especially when there is a need for positive pressure ventilation or supplemental oxygen. The objective was to evaluate (i) to what extent PO was used, (ii) the time and resources spent on the application of PO, and (iii) the proportion of time with a useful PO signal during newborn resuscitation. METHODS A prospective observational study was conducted at Stavanger University Hospital, Norway, between 6 June 2019 and 16 November 2021. Newborn resuscitations were video recorded, and the use of PO during the first ten minutes of resuscitation was recorded and analysed. RESULTS Of 7466 enrolled newborns, 289 (3.9%) received ventilation at birth. The resuscitation was captured on video in 230 cases, and these newborns were included in the analysis. PO was applied in 222 of 230 (97%) newborns, median (quartiles) 60 (24, 58) seconds after placement on the resuscitation table. The proportion of time used on application and adjustments of PO during ongoing ventilation and during the first ten minutes on the resuscitation table was 30% and 17%, respectively. Median two healthcare providers were involved in the PO application. Video of the PO monitor signal was available in 118 (53%) of the 222 newborns. The proportion of time with a useful PO signal during ventilation and during the first ten minutes on the resuscitation table was 5% and 35%, respectively. CONCLUSION In total, 97% of resuscitated newborns had PO applied, in line with resuscitation guidelines. However, the application of PO was time-consuming, and a PO signal was only obtained 5% of the time during positive pressure ventilation.
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Affiliation(s)
- Vilde Kolstad
- Department of Research, Stavanger University Hospital, 4019 Stavanger, Norway
| | - Hanne Pike
- Department of Paediatrics, Stavanger University Hospital, 4019 Stavanger, Norway
| | | | - Frederikke Buskov
- Department of Research, Stavanger University Hospital, 4019 Stavanger, Norway
| | - Hege Ersdal
- Faculty of Health Sciences, University of Stavanger, 4021 Stavanger, Norway
| | - Siren Rettedal
- Department of Research, Stavanger University Hospital, 4019 Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, 4021 Stavanger, Norway
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Kibsgaard A, Ersdal H, Kvaløy JT, Eilevstjønn J, Rettedal S. Newborns requiring resuscitation: Two thirds have heart rate ≥100 beats/minute in the first minute after birth. Acta Paediatr 2023; 112:697-705. [PMID: 36607256 DOI: 10.1111/apa.16659] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
AIM The aim was to study the prevalence of bradycardia at birth in newborns requiring positive pressure ventilation (PPV), distribution of first measured heart rate (HR), changes in HR before start of PPV and HR response to PPV. METHODS A population-based study including newborns ≥30 weeks' gestation receiving PPV at birth. HR was captured immediately after birth and continuously throughout resuscitation using the dry-electrode ECG device NeoBeat. Time of birth was registered in the Liveborn app. Provision of PPV was captured by video. RESULTS We included 98 newborns receiving PPV at birth. Among newborns with HR measured within 60 s after birth, median (quartiles) first HR was 112 (84, 149) bpm recorded 19 (14, 37) s after birth, of which 33% had first HR <100 and 10% had first HR <60 bpm respectively. First HR was widely distributed. Median HR at start PPV 69 s after birth was 129 bpm. In newborns with an initial low HR, HR typically remained low for 20 s of PPV before increasing rapidly over the next 20-30 s. CONCLUSIONS First measured HR was ≥100 bpm in two thirds of newborns receiving PPV. In bradycardic infants, HR did not increase until after 20 s of PPV.
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Affiliation(s)
- Amalie Kibsgaard
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Hege Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Jan Terje Kvaløy
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway.,Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | | | - Siren Rettedal
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Rettedal S, Kibsgaard A, Eilevstjønn J, Kvaløy JT, Bjorland PA, Markhus Pike H, Haynes J, Tysland TB, Størdal K, Holte K, Davis PG, Ersdal HL. Impact of immediate and continuous heart rate feedback by dry electrode ECG on time to initiation of ventilation after birth: protocol for a randomised controlled trial. BMJ Open 2022; 12:e061839. [PMID: 36691167 PMCID: PMC9454047 DOI: 10.1136/bmjopen-2022-061839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/21/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION 3%-8% of newborns need positive pressure ventilation (PPV) after birth. Heart rate (HR) is considered the most sensitive indicator of the newborns' condition and response to resuscitative interventions. According to guidelines, HR should be assessed and PPV initiated within 60 s after birth in non-breathing newborns. Dry electrode ECG can provide accurate feedback on HR immediately after birth and continuously during resuscitation. The impact of early and continuous HR feedback is unknown. METHOD AND ANALYSIS This single-centre randomised controlled trial seeks to determine if HR feedback by dry electrode ECG immediately after birth and continuously during newborn resuscitation results in more timely initiation of PPV, improved ventilation and short-term outcomes compared with standard HR assessment.In all newborns≥34 gestational weeks, the dry electrode ECG sensor is placed on the upper abdomen immediately after birth as an additional modality of HR assessment. The device records and stores HR signals. In intervention subjects, the HR display is visible to guide decision-making and further management, in control subjects the display is masked. Standard HR assessment is by stethoscope, gel-electrode ECG and/or pulse oximetry (PO).Time of birth is registered in the Liveborn app. Time of initiation and duration of PPV is calculated from video recordings. Ventilation parameters are retrieved from the ventilation monitor, oxygen saturation and HR from the PO and gel-electrode ECG monitors.The primary endpoint is proportion of resuscitated newborns who receive PPV within 60 s after birth. To detect a 50% increase with power of 90% using an overall significance level of 0.05 and 1 interim analysis, 169 newborns are needed in each group. ETHICS AND DISSEMINATION Approval by the Norwegian National Research Ethics Committee West (2018/338). Parental consent is sought at routine screening early in pregnancy. The results will be published in peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER NCT03849781.
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Affiliation(s)
- Siren Rettedal
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Amalie Kibsgaard
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Joar Eilevstjønn
- Strategic Research, Laerdal Medical AS, Stavanger, Rogaland, Norway
| | - Jan Terje Kvaløy
- Mathematics and Physics, Department of Mathematics and Natural Science, University of Stavanger, Stavanger, Norway
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | | | - Hanne Markhus Pike
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Joanna Haynes
- Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | | | - Ketil Størdal
- Department of Pediatric Research, University of Oslo, Oslo, Norway
- Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Kari Holte
- Department of Pediatrics and Adolescent Medicine, Ostfold Hospital, Gralum, Østfold, Norway
| | - Peter G Davis
- Newborn Research, The Royal Women's Hospital at Sandringham, Sandringham, Victoria, Australia
| | - Hege Langli Ersdal
- Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
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Schwindt EM, Stockenhuber R, Kainz T, Stumptner N, Henkel M, Hefler L, Schwindt JC. Neonatal simulation training decreases the incidence of chest compressions in term newborns. Resuscitation 2022; 178:109-115. [PMID: 35700883 DOI: 10.1016/j.resuscitation.2022.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
Abstract
AIM OF THE STUDY To determine the effectiveness of a multidimensional neonatal simulation-based medical education training programme on direct and indirect patient outcome parameters. METHODS This was a retrospective analytical study with a historical control group in a level II neonatal care unit (1,700 births per year). A multidimensional interdisciplinary training programme on neonatal resuscitation was implemented in 2015; pre-training (2012-2014) and post-training (2015-2019) eras were compared in terms of mortality (direct outcome) and the received intervention level immediately after birth (indirect outcome). Intervention levels were defined as follows: A) short-term non-invasive ventilation, B) prolonged non-invasive ventilation (>5 inflation breaths), C) chest compressions. RESULTS Of 13,950 neonates born during the study period, 826 full-term newborns received one of the three intervention levels for adaptation after birth. A total of 284 (34.4%) patients received short-term non-invasive ventilation (A), 477 (57.8%) had prolonged ventilation (B), and 65 (7.9%) chest compressions (C), respectively. Comparing the pre- and post-training eras, there was no significant reduction in mortality, and no significant changes were found in groups A or B. However, the risk for chest compressions (group C) decreased significantly from 0.91% in the pre-training era to 0.20% in the post-training era (p < 0.001). CONCLUSION Although there was no significant effect on neonatal mortality, regular interdisciplinary simulation training decreased the number of administered chest compressions immediately after birth. Further studies are needed to test indirect outcome-related parameters, such as frequency of chest compressions as a measure of effectiveness and impact of medical training.
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Affiliation(s)
- Eva M Schwindt
- Medical University Vienna, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Waehringerguertel 18-20, 1090 Vienna, Austria; STAR - SIMCharacters Training and Research, Lehargasse 1, 1090 Vienna, Austria; Neonatal Working Group, Austrian Resuscitation Council, Villefortgasse 22, 8010 Graz, Austria
| | | | - Theresa Kainz
- Medical University Vienna, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Waehringerguertel 18-20, 1090 Vienna, Austria
| | - Nicola Stumptner
- Department of Paediatrics and Adolescent Medicine, Hospital Barmherzige Schwestern Linz, Seilerstaette 4, 4010 Linz, Austria
| | - Martin Henkel
- Department of Paediatrics and Adolescent Medicine, Hospital Barmherzige Schwestern Linz, Seilerstaette 4, 4010 Linz, Austria
| | - Lukas Hefler
- Department of Obstetrics and Gynecology, Konventhospital Barmherzige Brueder and Ordensklinikum Linz, Seilerstaette 2-4, 4010 Linz, Austria
| | - Jens C Schwindt
- STAR - SIMCharacters Training and Research, Lehargasse 1, 1090 Vienna, Austria; Neonatal Working Group, Austrian Resuscitation Council, Villefortgasse 22, 8010 Graz, Austria
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10
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Biswas A, Ho SKY, Yip WY, Kader KBA, Kong JY, Ee KTT, Baral VR, Chinnadurai A, Quek BH, Yeo CL. Singapore Neonatal Resuscitation Guidelines 2021. Singapore Med J 2021; 62:404-414. [PMID: 35001116 PMCID: PMC8804489 DOI: 10.11622/smedj.2021110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
Neonatal resuscitation is a coordinated, team-based series of timed sequential steps that focuses on a transitional physiology to improve perinatal and neonatal outcomes. The practice of neonatal resuscitation has evolved over time and continues to be shaped by emerging evidence as well as key opinions. We present the revised Neonatal Resuscitation Guidelines for Singapore 2021. The recommendations from the International Liaison Committee on Resuscitation Neonatal Task Force Consensus on Science and Treatment Recommendations (2020) and guidelines from the American Heart Association and European Resuscitation Council were compared with existing guidelines. The recommendations of the Neonatal Subgroup of the Singapore Resuscitation and First Aid Council were derived after the work group discussed and appraised the current available evidence and their applicability to local clinical practice.
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Affiliation(s)
- Agnihotri Biswas
- Department of Neonatology, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Neonatal Group, Paediatric Subcommittee, Singapore Resuscitation and First Aid Council, Singapore
| | - Selina Kah Ying Ho
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Wai Yan Yip
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore
| | - Khadijah Binti Abdul Kader
- Department of Neonatology, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore
| | - Juin Yee Kong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore
| | - Kenny Teong Tai Ee
- Neonatal Group, Paediatric Subcommittee, Singapore Resuscitation and First Aid Council, Singapore
- Kinder Clinic Pte Ltd, Singapore
| | - Vijayendra Ranjan Baral
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Amutha Chinnadurai
- Department of Neonatology, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bin Huey Quek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Neonatal Group, Paediatric Subcommittee, Singapore Resuscitation and First Aid Council, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore
| | - Cheo Lian Yeo
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Neonatal Group, Paediatric Subcommittee, Singapore Resuscitation and First Aid Council, Singapore
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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11
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Bjorland PA, Ersdal HL, Eilevstjønn J, Øymar K, Davis PG, Rettedal SI. Changes in heart rate from 5 s to 5 min after birth in vaginally delivered term newborns with delayed cord clamping. Arch Dis Child Fetal Neonatal Ed 2021; 106:311-315. [PMID: 33172876 PMCID: PMC8070647 DOI: 10.1136/archdischild-2020-320179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine heart rate centiles during the first 5 min after birth in healthy term newborns delivered vaginally with delayed cord clamping. DESIGN Single-centre prospective observational study. SETTING Stavanger University Hospital, Norway, March-August 2019. PATIENTS Term newborns delivered vaginally were eligible for inclusion. Newborns delivered by vacuum or forceps or who received any medical intervention were excluded. INTERVENTIONS A novel dry electrode electrocardiography monitor (NeoBeat) was applied to the newborn's chest immediately after birth. The newborns were placed on their mother's chest or abdomen, dried and stimulated, and cord clamping was delayed for at least 1 min. MAIN OUTCOME MEASURES Heart rate was recorded at 1 s intervals, and the 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles were calculated from 5 s to 5 min after birth. RESULTS 898 newborns with a mean (SD) birth weight 3594 (478) g and gestational age 40 (1) weeks were included. The heart rate increased rapidly from median (IQR) 122 (98-146) to 168 (146-185) beats per minute (bpm) during the first 30 s after birth, peaking at 175 (157-189) bpm at 61 s after birth, and thereafter slowly decreasing. The third centile reached 100 bpm at 34 s, suggesting that heart rates <100 bpm during the first minutes after birth are uncommon in healthy newborns after delayed cord clamping. CONCLUSION This report presents normal heart rate centiles from 5 s to 5 min after birth in healthy term newborns delivered vaginally with delayed cord clamping.
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Affiliation(s)
- Peder Aleksander Bjorland
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway .,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Hege Langli Ersdal
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway,Department of Health Science, University of Stavanger, Stavanger, Norway
| | - Joar Eilevstjønn
- Department of Strategic Research, Laerdal Medical AS, Stavanger, Norway
| | - Knut Øymar
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Peter G Davis
- Department of Newborn Research, The Royal Women’s Hospital at Sandringham, Sandringham, Victoria, Australia
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12
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Pike H, Eilevstjønn J, Bjorland P, Linde J, Ersdal H, Rettedal S. Heart rate detection properties of dry-electrode ECG compared to conventional 3-lead gel-electrode ECG in newborns. BMC Res Notes 2021; 14:166. [PMID: 33933159 PMCID: PMC8088562 DOI: 10.1186/s13104-021-05576-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/20/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the accuracy of heart rate detection properties of a novel, wireless, dry-electrode electrocardiogram (ECG) device, NeoBeat®, to that of a conventional 3-lead gel-electrode ECG monitor (PropaqM®) in newborns. Results The study population had a mean gestational age of 39 weeks and 2 days (1.5 weeks) and birth weight 3528 g (668 g). There were 950 heart rate notations from each device, but heart rate was absent from the reference monitor in 14 of these data points, leaving 936 data pairs to compare. The mean (SD) difference when comparing NeoBeat to the reference monitor was -0.25 (9.91) beats per minute (bpm) (p = 0.44). There was a deviation of more than 10 bpm in 7.4% of the data pairs, which primarily (78%) was attributed to ECG signal disturbance, and secondly (22%) due to algorithm differences between the devices. Excluding these outliers, the correlation was equally consistent (r2 = 0.96) in the full range of heart rate captured measurements with a mean difference of − 0.16 (3.09) bpm. The mean difference was less than 1 bpm regardless of whether outliers were included or not. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05576-x.
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Affiliation(s)
- Hanne Pike
- Department of Paediatrics, Stavanger University Hospital, Post Box 8100, 4068, Stavanger, Norway
| | | | - Peder Bjorland
- Department of Paediatrics, Stavanger University Hospital, Post Box 8100, 4068, Stavanger, Norway
| | - Jørgen Linde
- Department of Paediatrics, Stavanger University Hospital, Post Box 8100, 4068, Stavanger, Norway
| | - Hege Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Siren Rettedal
- Department of Paediatrics, Stavanger University Hospital, Post Box 8100, 4068, Stavanger, Norway.
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13
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Helldén D, Myrnerts Höök S, Pejovic NJ, Mclellan D, Lubulwa C, Tylleskär T, Alfven T. Neonatal resuscitation practices in Uganda: a video observational study. BMJ Paediatr Open 2021; 5:e001092. [PMID: 34595356 PMCID: PMC8442103 DOI: 10.1136/bmjpo-2021-001092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Neonatal mortality, often due to birth asphyxia, remains stubbornly high in sub-Saharan Africa. Guidelines for neonatal resuscitation, where achieving adequate positive pressure ventilation (PPV) is key, have been implemented in low-resource settings. However, the actual clinical practices of neonatal resuscitation have rarely been examined in these settings. The primary aim of this prospective observational study was to detail the cumulative proportion of time with ventilation during the first minute on the resuscitation table of neonates needing PPV at the Mulago National Referral Hospital in Kampala, Uganda. METHODS From November 2015 to January 2016, resuscitations of non-breathing neonates by birth attendants were video-recorded using motion sensor cameras. The resuscitation practices were analysed using the application NeoTapAS and compared between those taking place in the labour ward and those in theatre through Fisher's exact test and Wilcoxon rank-sum test. RESULTS From 141 recorded resuscitations, 99 were included for analysis. The time to initiation of PPV was 66 (42-102) s overall, and there was minimal PPV during the first minute in both groups with 0 (0-10) s and 0 (0-12) s of PPV, respectively. After initiating PPV the overall duration of interruptions during the first minute was 28 (18-37) s. Majority of interruptions were caused by stimulation (28%), unknown reasons (25%) and suction (22%). CONCLUSIONS Our findings show a low adherence to standard resuscitation practices in 2015-2016. This emphasises the need for continuous educational efforts and investments in staff and adequate resources to increase the quality of clinical neonatal resuscitation practices in low-resource settings.
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Affiliation(s)
- Daniel Helldén
- Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Susanna Myrnerts Höök
- Global Public Health, Karolinska Institute, Stockholm, Sweden.,Center for International Health, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Nicolas J Pejovic
- Global Public Health, Karolinska Institute, Stockholm, Sweden.,Center for International Health, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Dan Mclellan
- Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Clare Lubulwa
- Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Thorkild Tylleskär
- Center for International Health, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway.,Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tobias Alfven
- Global Public Health, Karolinska Institute, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
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