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Koo J, Cheung PY, Pichler G, Solevåg AL, Law BHY, Katheria AC, Schmölzer GM. Chest compressions superimposed with sustained inflation during neonatal cardiopulmonary resuscitation: are we ready for a clinical trial? Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326769. [PMID: 38453436 DOI: 10.1136/archdischild-2023-326769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/17/2024] [Indexed: 03/09/2024]
Abstract
Neonates requiring cardiopulmonary resuscitation (CPR) are at risk of mortality and neurodevelopmental injury. Poor outcomes following the need for chest compressions (CCs) in the delivery room prompt the critical need for improvements in resuscitation strategies. This article explores a technique of CPR which involves CCs with sustained inflation (CC+SI). Unique features of CC+SI include (1) improved tidal volume delivery, (2) passive ventilation during compressions, (3) uninterrupted compressions and (4) improved stability of cerebral blood flow during resuscitation. CC+SI has been shown in animal studies to have improved time to return of spontaneous circulation and reduced mortality without significant increase in markers of inflammation and injury in the lung and brain, compared with standard CPR. The mechanics of CCs, rate of compressions, ventilation strategies and compression-to-ventilation ratios are detailed here. A large randomised controlled trial comparing CC+SI versus the current 3:1 compression-to-ventilation ratio is needed, given the growing evidence of its potential benefits.
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Affiliation(s)
- Jenny Koo
- Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
| | - Po-Yin Cheung
- 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
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Abstract
OBJECTIVE Mask positive pressure ventilation (PPV) in the delivery room is routinely delivered with set peak inflation pressures. To aid mask PPV, stand-alone respiratory function monitors (RFMs) have been used in the delivery room, while ventilator-based, volume-targeted ventilation (VTV) is routinely used in the neonatal intensive care unit (NICU). DESIGN This is a prospective, randomised, crossover simulation study. Participants were briefly trained to use a neonatal ventilator for volume-targeted mask ventilation (VTV-PPV), then performed mask ventilation on a manikin in a randomised order using VTV-PPV, T-piece PPV or T-piece PPV with RFM visible. SETTING In situ in a neonatal resuscitation room within a level 3 NICU. PARTICIPANTS Healthcare professionals (HCPs) trained in neonatal resuscitation with experience as team leaders. INTERVENTIONS Semiautomated, ventilator-based VTV-PPV using two-hand hold versus manual PPV via a T-piece device (T-piece, RFM masked) versus manual PPV with RFM visible using one-hand hold. MAIN OUTCOME MEASURES Respiratory characteristics including % mask leak, tidal volume (VT) and peak inflation pressure (PIP). RESULTS Thirty-two HCPs (23 (72%) female and 9 (28%) male) participated. The median mask leak was significantly lower with 'VTV-PPV' (11%, IQR 0%-14%) compared with both 'T-piece, RFM visible' (82%, IQR 30%-91%) and 'T-piece, RFM masked' (81%, IQR 47%-91%) (p<0.0001). The median delivered VT was 4.1 mL/kg (IQR 3.9-4.4) with VTV-PPV compared with 2.1 mL/kg (IQR 1.2-9) with T-piece, RFM visible and 1.8 mL/kg (IQR 1.1-5.8) with T-piece, RFM masked (p=0.0496). PIP was also significantly lower with VTV-PPV. CONCLUSION During neonatal simulation, VTV-PPV reduced mask leak and allowed for consistent VT delivery compared with T-piece with and without RFM guidance.
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Affiliation(s)
- Brenda Hiu Yan Law
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
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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:fetalneonatal-2023-326383. [PMID: 38212104 DOI: 10.1136/archdischild-2023-326383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Madani Kia T, McKinney M, Dicken B, Thompson A, Sarlieve P, Law BHY. Clinical curiosity: How long should we wait? Management of ventilator associated pneumatocele in an extremely preterm infant. Pediatr Pulmonol 2024. [PMID: 38193785 DOI: 10.1002/ppul.26834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Tina Madani Kia
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Martha McKinney
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Bryan Dicken
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Adrienne Thompson
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Philippe Sarlieve
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
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Law BHY, Madani Kia T, Trinh F, Schmölzer GM. Mask ventilation using volume-targeted neonatal ventilator for neonatal resuscitation: a randomised cross-over simulation study. Arch Dis Child Fetal Neonatal Ed 2023; 109:46-51. [PMID: 37369598 DOI: 10.1136/archdischild-2023-325320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE To use simulations to compare a novel mask ventilation method using a neonatal ventilator, with mask ventilation using a T-piece resuscitator, to study human factors prior to clinical testing. DESIGN Prospective randomised cross-over simulation study. Participants were briefly trained to use a neonatal ventilator for mask ventilation. Each participant was fitted with eye-tracking glasses to record visual attention (VA) and performed two simulated preterm neonatal resuscitations in a randomised sequence. SETTING In situ in a neonatal resuscitation room within a Level 3 neonatal intensive care unit. PARTICIPANTS Healthcare professionals (HCPs) trained in neonatal resuscitation with experience as team leaders. INTERVENTIONS Semiautomated, ventilator-based, volume-targeted positive pressure mask ventilation (VTV-PPV) versus manual mask ventilation via T-piece device (T-piece PPV). MAIN OUTCOME MEASURES Subjective workload (Surgical Task Load Index, SURG-TLX), VA, quantitative and qualitative postsimulation survey responses. RESULTS Thirty HCPs participated. HCPs reported higher total SURG-TLX scores (43.5/120 vs 33.8/120) and higher scores in mental demand (8.2/20 vs 5.6/20), physical demand (6.6/20 vs 5.1/20), task complexity (8.2/20 vs 6/20) and situational stress (8.3/20 vs 5.9/20) for VTV-PPV. Temporal demand and distraction scores were similar. While participants took longer to complete VTV-PPV simulations, participants dedicated similar a %VA to the mannikin and T-piece gauges or ventilator screen. More participants increased the rate of ventilation during VTV-PPV; other corrective steps were similar. Overall, participants rated VTV-PPV positively. Participants identified potential challenges with physical ergonomics, cognition and teamwork. CONCLUSION Using a neonatal ventilator to perform volume-targeted PPV is feasible, but human factors need to be considered.
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Affiliation(s)
- Brenda Hiu Yan Law
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tina Madani Kia
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Faith Trinh
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Levy P, Thomas AR, Law BHY, Joynt C, Gupta R, Elshenawy S, Reed D, Pavlek LR, Shepherd J, Gowda S, Johnson BA, Ball M, Ali N. Multicentre study protocol comparing standard NRP to deveLoped Educational Modules for Resuscitation of Neonates in the Delivery Room with Congenital Heart Disease (LEARN-CHD). BMJ Open 2023; 13:e067391. [PMID: 37019485 PMCID: PMC10083808 DOI: 10.1136/bmjopen-2022-067391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION Infants born with critical congenital heart defects (CCHDs) have unique transitional pathophysiology that often requires special resuscitation and management considerations in the delivery room (DR). While much is known about neonatal resuscitation of infants with CCHDs, current neonatal resuscitation guidelines such as the neonatal resuscitation programme (NRP) do not include algorithm modifications or education specific to CCHDs. The implementation of CCHD specific neonatal resuscitation education is further hampered by the large number of healthcare providers (HCPs) that need to be reached. Online learning modules (eLearning) may provide a solution but have not been designed or tested for this specific learning need. Our objective in this study is to design targeted eLearning modules for DR resuscitation of infants with specific CCHDs and compare HCP knowledge and team performance in simulated resuscitations among HCPs exposed to these modules compared with directed CCHD readings. METHODS AND ANALYSIS In a prospective multicentre trial, HCP proficient in standard NRP education curriculum are randomised to either (a) directed CCHD readings or (b) CCHD eLearning modules developed by the study team. The efficacy of these modules will be evaluated using (a) individual preknowledge/postknowledge testing and (b) team-based resuscitation simulations. ETHICS AND DISSEMINATION This study protocol is approved by nine participating sites: the Boston Children's Hospital Institutional Review Board (IRB-P00042003), University of Alberta Research Ethics Board (Pro00114424), the Children's Wisconsin IRB (1760009-1), Nationwide Children's Hospital IRB (STUDY00001518), Milwaukee Children's IRB (1760009-1) and University of Texas Southwestern IRB (STU-2021-0457) and is under review at following sites: University of Cincinnati, Children's Healthcare of Atlanta, Children's Hospital of Los Angeles and Children's Mercy-Kansas City. Study results will be disseminated to participating individuals in a lay format and presented to the scientific community at paediatric and critical care conferences and published in relevant peer-reviewed journals.
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Affiliation(s)
- Philip Levy
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Alyssa R Thomas
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Brenda Hiu Yan Law
- Department of Pediatrics, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Chloe Joynt
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ruby Gupta
- Department of Pediatrics, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Summer Elshenawy
- Department of Pediatrics, Emory University School of Medicine Atlanta, Atlanta, Georgia, USA
| | - Danielle Reed
- Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - Leeann R Pavlek
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jennifer Shepherd
- Department of Pediatrics, Keck School of Medicine University of Southern California, Los Angeles, California, USA
| | - Sharada Gowda
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Beth Ann Johnson
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Molly Ball
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Noorjahan Ali
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Katheria AC, Law BHY, Poeltler D, Rich W, Ines F, Schmölzer GM, Lakshminrusimha S. Cardiac and cerebral hemodynamics with umbilical cord milking compared with early cord clamping: A randomized cluster crossover trial. Early Hum Dev 2023; 177-178:105728. [PMID: 36827750 PMCID: PMC10034920 DOI: 10.1016/j.earlhumdev.2023.105728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE A large, randomized cluster cross-over trial (N = 1730) comparing intact umbilical cord milking (UCM) to early cord clamping (ECC) in non-vigorous near-term/term newborns demonstrated a reduction in cardiorespiratory interventions at birth and less moderate to severe hypoxic ischemic encephalopathy. We evaluated changes in cerebral tissue oxygenation (StO2), pulse oximetry (SpO2), pulse rate and fraction of inspired oxygen (FiO2) during the first 10 min of life in a subset of infants enrolled in the parent trial. STUDY DESIGN Infants enrolled in the Milking in Non-Vigorous Infants trial that had StO2 monitoring at birth were included in the sub-study conducted at 3 hospitals the US and Canada. A near-infrared spectroscopy sensor, pulse oximeter and electrocardiogram electrodes were placed. Pulse rate, StO2, SpO2, and FiO2 were collected for the first 10 min after birth. Longitudinal models were used to compare effects of UCM and ECC. RESULTS Thirty-four infants had StO2 data. Fifteen of these infants received UCM and 19 had ECC. Infants receiving UCM had similar heart rates, SpO2, and StO2 values, but were exposed to less FiO2 over the first 10 min of life than infants with ECC (0.26 ± 0.12 vs. 0.81 ± 0.05 at 10 min). CONCLUSION Non-vigorous term/near term infants who received UCM at birth required lower FiO2 after delivery when compared to infants who umbilical cords were clamped soon after birth while achieving similar peripheral and cerebral oxygenation. Cord milking may be a potential option for placental transfusion in non-vigorous near term/term infants when delayed cord clamping cannot be performed.
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Affiliation(s)
- Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States.
| | | | - Debra Poeltler
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
| | - Wade Rich
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
| | - Felix Ines
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
| | | | - Satyan Lakshminrusimha
- Department of Pediatrics, University of California Davis Children's Hospital, Sacramento, CA, United States
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Mukerji A, Rempel E, Thabane L, Johnson H, Schmolzer G, Law BHY, Jani P, Tracy M, Rottkamp C, Keszler M, Kirpalani H, Shah PS. High continuous positive airway pressures versus non-invasive positive pressure ventilation in preterm neonates: protocol for a multicentre pilot randomised controlled trial. BMJ Open 2023; 13:e069024. [PMID: 36787974 PMCID: PMC9930542 DOI: 10.1136/bmjopen-2022-069024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Low pressure nasal continuous positive airway pressure (nCPAP) has long been the mainstay of non-invasive respiratory support for preterm neonates, at a constant distending pressure of 5-8 cmH2O. When traditional nCPAP pressures are insufficient, other modes including nasal intermittent positive pressure ventilation (NIPPV) are used. In recent years, high nCPAP pressures (≥9 cmH2O) have also emerged as an alternative. However, the comparative benefits and risks of these modalities remain unknown. METHODS AND ANALYSIS In this multicentre pilot randomised controlled trial, infants <29 weeks' gestational age (GA) who either: (A) fail treatment with traditional nCPAP or (B) being extubated from invasive mechanical ventilation with mean airway pressure ≥10 cmH2O, will be randomised to receive either high nCPAP (positive end-expiratory pressure 9-15 cmH2O) or NIPPV (target mean Paw 9-15 cmH2O). Primary outcome is feasibility of the conduct of a larger, definitive trial as assessed by rates of recruitment and protocol violations. The main secondary outcome is failure of assigned treatment within 7 days postrandomisation. Multiple other clinical outcomes including bronchopulmonary dysplasia will be ascertained. All randomised participants will be analysed using intention to treat. Baseline and demographic variables as well as outcomes will be summarised and compared using univariate analyses, and a p<0.05 will be considered significant. ETHICS AND DISSEMINATION The trial has been approved by the respective research ethics boards at each institution (McMaster Children's Hospital: Hamilton integrated REB approval #2113; Royal Alexandra Hospital: Health Research Ethics Board approval ID Pro00090244; Westmead Hospital: Human Research Ethics Committee approval ID 2022/ETH01343). Written, informed consent will be obtained from all parents/guardians prior to study enrolment. The findings of this pilot study will be disseminated via presentations at national and international conferences and via publication in a peer-reviewed journal. Social media platforms including Twitter will also be used to generate awareness. TRIAL REGISTRATION NUMBER NCT03512158.
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Affiliation(s)
- Amit Mukerji
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Emily Rempel
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Heather Johnson
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Georg Schmolzer
- Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Brenda Hiu Yan Law
- Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Pranav Jani
- Department of Neonatology, Westmead Hospital, Westmead, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Tracy
- Sydney Medical School, The University if Sydney, Sydney, New South Wales, Australia
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Catherine Rottkamp
- Department of Pediatrics, University of California Davis, Davis, California, USA
| | - Martin Keszler
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Haresh Kirpalani
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Prakesh S Shah
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Katheria AC, Clark E, Yoder B, Schmölzer GM, Yan Law BH, El-Naggar W, Rittenberg D, Sheth S, Mohamed MA, Martin C, Vora F, Lakshminrusimha S, Underwood M, Mazela J, Kaempf J, Tomlinson M, Gollin Y, Fulford K, Goff Y, Wozniak P, Baker K, Rich W, Morales A, Varner M, Poeltler D, Vaucher Y, Mercer J, Finer N, El Ghormli L, Rice MM. Umbilical cord milking in nonvigorous infants: a cluster-randomized crossover trial. Am J Obstet Gynecol 2023; 228:217.e1-217.e14. [PMID: 35970202 PMCID: PMC9877105 DOI: 10.1016/j.ajog.2022.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/15/2022] [Accepted: 08/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Delayed cord clamping and umbilical cord milking provide placental transfusion to vigorous newborns. Delayed cord clamping in nonvigorous newborns may not be provided owing to a perceived need for immediate resuscitation. Umbilical cord milking is an alternative, as it can be performed more quickly than delayed cord clamping and may confer similar benefits. OBJECTIVE We hypothesized that umbilical cord milking would reduce admission to the neonatal intensive care unit compared with early cord clamping in nonvigorous newborns born between 35 and 42 weeks' gestation. STUDY DESIGN This was a pragmatic cluster-randomized crossover trial of infants born at 35 to 42 weeks' gestation in 10 medical centers in 3 countries between January 2019 and May 2021. The centers were randomized to umbilical cord milking or early cord clamping for approximately 1 year and then crossed over for an additional year or until the required number of consented subjects was reached. Waiver of consent as obtained in all centers to implement the intervention. Infants were eligible if nonvigorous at birth (poor tone, pale color, or lack of breathing in the first 15 seconds after birth) and were assigned to umbilical cord milking or early cord clamping according to their birth hospital randomization assignment. The baseline characteristics and outcomes were collected following deferred informed consent. The primary outcome was admission to the neonatal intensive care unit for predefined criteria. The main safety outcome was hypoxic-ischemic encephalopathy. Data were analyzed by the intention-to-treat concept. RESULTS Among 16,234 screened newborns, 1780 were eligible (905 umbilical cord milking, 875 early cord clamping), and 1730 had primary outcome data for analysis (97% of eligible; 872 umbilical cord milking, 858 early cord clamping) either via informed consent (606 umbilical cord milking, 601 early cord clamping) or waiver of informed consent (266 umbilical cord milking, 257 early cord clamping). The difference in the frequency of neonatal intensive care unit admission using predefined criteria between the umbilical cord milking (23%) and early cord clamping (28%) groups did not reach statistical significance (modeled odds ratio, 0.69; 95% confidence interval, 0.41-1.14). Umbilical cord milking was associated with predefined secondary outcomes, including higher hemoglobin (modeled mean difference between umbilical cord milking and early cord clamping groups 0.68 g/dL, 95% confidence interval, 0.31-1.05), lower odds of abnormal 1-minute Apgar scores (Apgar ≤3, 30% vs 34%, crude odds ratio, 0.72; 95% confidence interval, 0.56-0.92); cardiorespiratory support at delivery (61% vs 71%, modeled odds ratio, 0.57; 95% confidence interval, 0.33-0.99), and therapeutic hypothermia (3% vs 4%, crude odds ratio, 0.57; 95% confidence interval, 0.33-0.99). Moderate-to-severe hypoxic-ischemic encephalopathy was significantly less common with umbilical cord milking (1% vs 3%, crude odds ratio, 0.48; 95% confidence interval, 0.24-0.96). No significant differences were observed for normal saline bolus, phototherapy, abnormal 5-minute Apgar scores (Apgar ≤6, 15.7% vs 18.8%, crude odds ratio, 0.81; 95% confidence interval, 0.62-1.06), or a serious adverse event composite of death before discharge. CONCLUSION Among nonvigorous infants born at 35 to 42 weeks' gestation, umbilical cord milking did not reduce neonatal intensive care unit admission for predefined criteria. However, infants in the umbilical cord milking arm had higher hemoglobin, received less delivery room cardiorespiratory support, had a lower incidence of moderate-to-severe hypoxic-ischemic encephalopathy, and received less therapeutic hypothermia. These data may provide the first randomized controlled trial evidence that umbilical cord milking in nonvigorous infants is feasible, safe and, superior to early cord clamping.
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MESH Headings
- Female
- Humans
- Infant, Newborn
- Pregnancy
- Blood Transfusion
- Constriction
- Cross-Over Studies
- Hemoglobins
- Hypoxia-Ischemia, Brain/etiology
- Infant, Premature
- Placenta
- Umbilical Cord/surgery
- Umbilical Cord Clamping/methods
- Infant, Premature, Diseases/surgery
- Infant, Premature, Diseases/therapy
- Infant, Newborn, Diseases/surgery
- Infant, Newborn, Diseases/therapy
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Affiliation(s)
- Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA.
| | - Erin Clark
- Division of Maternal-Fetal Medicine, The University of Utah School of Medicine, Salt Lake City, UT
| | - Bradley Yoder
- Division of Neonatology, The University of Utah School of Medicine, Salt Lake City, UT
| | - Georg M Schmölzer
- Division of Neonatal-Perinatal Care, University of Alberta, Alberta, Canada
| | - Brenda Hiu Yan Law
- Division of Neonatal-Perinatal Care, University of Alberta, Alberta, Canada
| | - Walid El-Naggar
- Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Rittenberg
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheetal Sheth
- Department of Obstetrics and Gynecology, The GW Medical Faculty Associates, Washington, DC
| | - Mohamed A Mohamed
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH
| | | | - Farha Vora
- Loma Linda Health University, Loma Linda, CA
| | | | - Mark Underwood
- University of California Davis Children's Hospital, Sacramento, CA
| | - Jan Mazela
- Poznan University of Medical Science, Poznan, Poland
| | - Joseph Kaempf
- Providence St. Vincent Medical Center, Providence Health System, Oregon, United States of America
| | - Mark Tomlinson
- Providence St. Vincent Medical Center, Providence Health System, Oregon, United States of America
| | - Yvonne Gollin
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA
| | | | | | - Paul Wozniak
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA; Sharp Grossmont Hospital, La Mesa, CA
| | - Katherine Baker
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA
| | - Wade Rich
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA
| | - Ana Morales
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA
| | - Michael Varner
- Division of Maternal-Fetal Medicine, The University of Utah School of Medicine, Salt Lake City, UT
| | - Debra Poeltler
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA
| | | | - Judith Mercer
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA
| | - Neil Finer
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA
| | - Laure El Ghormli
- The George Washington University Biostatistics Center, Washington, DC
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Chen LGR, Law BHY. Use of eye-tracking to evaluate human factors in accessing neonatal resuscitation equipment and medications for advanced resuscitation: A simulation study. Front Pediatr 2023; 11:1116893. [PMID: 37009282 PMCID: PMC10060515 DOI: 10.3389/fped.2023.1116893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/28/2023] [Indexed: 04/04/2023] Open
Abstract
Introduction Emergency neonatal resuscitation equipment is often organized into "code carts". Simulation studies previously examined human factors of neonatal code carts and equipment; however, visual attention analysis with eye-tracking might further inform equipment design. Objectives To evaluate human factors of neonatal resuscitation equipment by: (1) comparing epinephrine preparation speed from adult pre-filled syringe vs. medication vial, (2) comparing equipment retrieval times from two carts and (3) utilizing eye-tracking to study visual attention and user experience. Methods We conducted a 2-site randomized cross-over simulation study. Site 1 is a perinatal NICU with carts focused on airway management. Site 2 is a surgical NICU with carts improved with compartments and task-based kits. Participants were fitted with eye-tracking glasses then randomized to prepare two epinephrine doses using two methods, starting with an adult epinephrine prefilled syringe or a multiple access vial. Participants then obtained items for 7 tasks from their local cart. Post-simulation, participants completed surveys and semi-structured interviews while viewing eye-tracked video of their performance. Epinephrine preparation times were compared between the two methods. Equipment retrieval times and survey responses were compared between sites. Eye-tracking was analyzed for areas of interest (AOIs) and gaze shifts between AOIs. Interviews were subject to thematic analysis. Results Forty HCPs participated (20/site). It was faster to draw the first epinephrine dose using the medication vial (29.9s vs. 47.6s, p < 0.001). Time to draw the second dose was similar (21.2s vs. 19s, p = 0.563). It was faster to obtain equipment from the Perinatal cart (164.4s v 228.9s, p < 0.027). Participants at both sites found their carts easy to use. Participants looked at many AOIs (54 for Perinatal vs. 76 for Surgical carts, p < 0.001) with 1 gaze shifts/second for both.Themes for epinephrine preparation include: Facilitators and Threats to Performance, and Discrepancies due to Stimulation Conditions. Themes for code carts include: Facilitators and Threats to Performance, Orienting with Prescan, and Suggestions for Improvement. Suggested cart improvements include: adding prompts, task-based grouping, and positioning small equipment more visibly. Task-based kits were welcomed, but more orientation is needed. Conclusions Eye-tracked simulations provided human factors assessment of emergency neonatal code carts and epinephrine preparation.
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Ediger K, Rashid M, Law BHY. What Is Teamwork? A Mixed Methods Study on the Perception of Teamwork in a Specialized Neonatal Resuscitation Team. Front Pediatr 2022; 10:845671. [PMID: 35498772 PMCID: PMC9046838 DOI: 10.3389/fped.2022.845671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/11/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Neonatal resuscitation is a team-based activity involving many decisions and tasks. Non-technical factors, such as teamwork, are increasingly recognized as impacting how well-neonatal resuscitation is performed, and therefore influencing infant outcomes. Prior studies on teamwork in neonatal resuscitation have focused on quantification of teamwork behaviors, or the effects of team training. This study aimed to explore healthcare providers' own perception of teamwork in this specialized environment to identify perceived barriers and facilitators to effective team functioning. METHODS This single-center exploratory sequential mixed methods study used two phases. First, semi-structured interviews were conducted, and thematic analysis used to identify themes. Subsequently, interview data informed the development of quantitative surveys to explore selected themes in the wider team. RESULTS From ten semi-structured interviews, seven themes were identified including: (1) Team Composition, (2) Effective Communication, (3) Team leadership, (4) Hierarchy, (5) Team Training, (6) Debriefing, and (7) Physical Environment. Perceived teamwork facilitators include role assignment, familiarity, team composition, talking out loud to maintain shared mental models, leadership, and team training. Perceived barriers included time pressures, ad hoc team, ineffective leadership, and space limitations. Selected themes (Communication, Speaking up, Hierarchy, and Leadership) were further explored via electronic surveys distributed via email to all members of the resuscitation team. There were 105 responses; a response rate of ~53%. All respondents agreed or strongly agreed that speaking up is important; however, not all felt comfortable doing so. Neonatal fellows (14%) and nurses (12%) were most likely to report not feeling comfortable speaking up. All respondents agreed that team communication is important to an effective resuscitation. Most respondents (91.5%) agreed that a hierarchy exists within the team; 54.3% believed that hierarchy positively contributes to effective resuscitation. All respondents agreed or strongly agreed that having a clearly defined leader is important in delivery room resuscitations. Ineffective leadership was the most cited reason for poor team communication. CONCLUSIONS In this mixed methods study of perceptions of teamwork within a specialized, multi-disciplinary neonatal resuscitation team, communication, hierarchy, and leadership were positively perceived and facilitates teamwork. However, even in this environment, some nurses and trainees expressed discomfort with speaking up.
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Affiliation(s)
- Krystyna Ediger
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Marghalara Rashid
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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12
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Chen LGR, Cheung PY, Law BHY. Lung Recruitment Using High-Frequency Oscillation Volume Guarantee in Preterm Infants with Evolving Bronchopulmonary Dysplasia. Neonatology 2022; 119:119-123. [PMID: 34727548 DOI: 10.1159/000519828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stepwise lung recruitment maneuvers (LRMs) may be used in ventilated preterm infants. However, its use in high-frequency oscillation with volume guarantee (HFO-VG) is not well studied. METHODS Preterm infants treated with HFO-VG who had LRMs were identified. Patient and respiratory parameters were recorded. RESULTS Ten infants, median GA 25+6 (IQR 24+2-27+0) weeks, and 21 LRMs were identified. LRMs were performed at a median age of 26 days, with a starting MAP of 16 (14-17) cm H2O and the highest MAP of 23.5 (22.0-24.8) cm H2O. Most (76%) resulted in immediate improved SpO2/FiO2. There were no sustained differences in median oxygen saturation index (8.4 vs. 9, p = 0.09), SpO2/FiO2 (1.8 vs. 1.8, p = 0.8), ∆P (21 vs. 23, p = 0.64), or transcutaneous CO2 (58 vs. 60, p = 0.84) in 24 h before and after LRMs. CONCLUSIONS In preterm infants with evolving bronchopulmonary dysplasia, LRMs on HFO-VG did not result in sustained improvement to oxygenation or ventilation.
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Affiliation(s)
- Linda Gai Rui Chen
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Po-Yin Cheung
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Brenda Hiu Yan Law
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
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Zehnder E, Law BHY, Schmölzer GM. Does parental presence affect workload during neonatal resuscitation? Arch Dis Child Fetal Neonatal Ed 2020; 105:559-561. [PMID: 32561565 DOI: 10.1136/archdischild-2020-318840] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/14/2020] [Accepted: 05/23/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Parents often prefer being present during neonatal resuscitation and benefit from this experience. We aim to determine if parental presence during neonatal resuscitation affects the perceived workload of healthcare providers. METHODS Perceived workload was measured using the multidimensional retrospective National Aeronautics and Space Administration Task Load Index survey. Over 3 months, healthcare providers were asked to complete a paper and pencil survey following their participation in a neonatal resuscitation. Surveys also collected healthcare providers' reports of parental presence during resuscitation. RESULTS 204 surveys were completed. Of these 183 (90%) had complete information about parental presence. Overall workload of healthcare professionals was significantly lower when at least one parent was present (33; 16-47) compared with when no parents were present (46; 29-57) during the resuscitation (p=0.0004). CONCLUSION This work supports the presence of parents during neonatal resuscitation. Parental presence during neonatal resuscitation was associated with decreased overall workload experienced by healthcare providers.
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Affiliation(s)
- Emily Zehnder
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Brenda Hiu Yan Law
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Law BHY, Schmölzer GM. Analysis of visual attention and team communications during neonatal endotracheal intubations using eye-tracking: An observational study. Resuscitation 2020; 153:176-182. [PMID: 32580005 DOI: 10.1016/j.resuscitation.2020.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Eye-tracking can be used to analyse visual attention (VA) of health care providers during clinical tasks. No study has examined eye-tracking during neonatal endotracheal intubation. We aimed to examine VA and team communications during endotracheal intubation using eye-tracking in the Neonatal Intensive Care Unit. METHODS Twenty-seven video-recordings were obtained using eye-tracking glasses worn by intubators during endotracheal intubation of stable neonates. Videos were analysed to obtain i) intubation duration and success, ii) areas of interest (AOIs), iii) duration spent on each AOI, iv) types and frequency of gaze-shifts between AOIs, and v) monitor looking behaviour, and vi) team communications of vital signs and verbal medication orders. RESULTS Twenty-four videos were of acceptable quality and analysed. Median attempt duration was 44.7 s. Success rate was 79%. Overall, 50% of VA was directed at the infant, with 23% of VA directed at equipment. There were 415 gaze-shifts types and 0.55 gaze-shifts/sec. Intubators glanced at the monitor spontaneously and rarely reported vital signs afterwards. Language used to communicate vital signs and medication orders varied. CONCLUSION During neonatal intubations, 50% of VA was directed away from the infant. Team communications were non-standard. Eye-tracking can be used to analyse human performance during neonatal resuscitation.
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Affiliation(s)
- Brenda Hiu Yan Law
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Canada; Department of Pediatrics, University of Alberta, Edmonton, Canada.
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Canada; Department of Pediatrics, University of Alberta, Edmonton, Canada
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Law BHY, Cheung PY, van Os S, Fray C, Schmölzer GM. Effect of monitor positioning on visual attention and situation awareness during neonatal resuscitation: a randomised simulation study. Arch Dis Child Fetal Neonatal Ed 2020; 105:285-291. [PMID: 31375503 DOI: 10.1136/archdischild-2019-316992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare situation awareness (SA), visual attention (VA) and protocol adherence in simulated neonatal resuscitations using two different monitor positions. DESIGN Randomised controlled simulation study. SETTINGS Simulation lab at the Royal Alexandra Hospital, Edmonton, Canada. PARTICIPANTS Healthcare providers (HCPs) with Neonatal Resuscitation Program (NRP) certification within the last 2 years and trained in neonatal endotracheal intubations. INTERVENTION HCPs were randomised to either central (eye-level on the radiant warmer) or peripheral (above eye-level, wall-mounted) monitor positions. Each led a complex resuscitation with a high-fidelity mannequin and a standardised assistant. To measure SA, situation awareness global assessment tool (SAGAT) was used, where simulations were paused at three predetermined points, with five questions asked each pause. Videos were analysed for SAGAT and adherence to a NRP checklist. Eye-tracking glasses recorded participants' VA. MAIN OUTCOME MEASURE The main outcome was SA as measured by composite SAGAT score. Secondary outcomes included VA and adherence to NRP checklist. RESULTS Thirty simulations were performed; 29 were completed per protocol and analysed. Twenty-two eye-tracking recordings were of sufficient quality and analysed. Median composite SAGAT was 11.5/15 central versus 11/15 peripheral, p=0.56. Checklist scores 46/50 central versus 46/50 peripheral, p=0.75. Most VA was directed at the mannequin (30.6% central vs 34.1% peripheral, p=0.76), and the monitor (28.7% central vs 20.5% peripheral, p=0.06). CONCLUSIONS Simulation, SAGAT and eye-tracking can be used to evaluate human factors of neonatal resuscitation. During simulated neonatal resuscitation, monitor position did not affect SA, VA or protocol adherence.
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Affiliation(s)
- Brenda Hiu Yan Law
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Po-Yin Cheung
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Sylvia van Os
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Caroline Fray
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Law BHY, Cheung PY, Aziz K, Schmölzer GM. Effect of COVID-19 Precautions on Neonatal Resuscitation Practice: A Balance Between Healthcare Provider Safety, Infection Control, and Effective Neonatal Care. Front Pediatr 2020; 8:478. [PMID: 33014919 PMCID: PMC7461943 DOI: 10.3389/fped.2020.00478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/08/2020] [Indexed: 12/14/2022] Open
Abstract
Adaptations have been proposed for resuscitation of infants born to women with COVID-19, to protect health care providers, maintain infection control, and limit post-natal transmission. Changes especially impact respiratory procedures, personal protective equipment (PPE) use, resuscitation environments, teamwork, and family involvement. Adding viral filters to ventilation devices and modifications to intubation procedures might hinder effective ventilation. PPE could delay resuscitation, hinder task performance, and degrade communication. Changes to resuscitation locations and team composition alter workflow and teamwork. Physical distancing measures and PPE impede family-integrated care. These disruptions need to be considered given the uncertainty of vertical transmission of SARS-CoV-2.
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Affiliation(s)
- Brenda Hiu Yan Law
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Po-Yin Cheung
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Khalid Aziz
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Law BHY, Cheung PY, Wagner M, van Os S, Zheng B, Schmölzer G. Analysis of neonatal resuscitation using eye tracking: a pilot study. Arch Dis Child Fetal Neonatal Ed 2018; 103:F82-F84. [PMID: 28824007 DOI: 10.1136/archdischild-2017-313114] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/03/2017] [Accepted: 07/18/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Visual attention (VA) is important for situation awareness and decision-making. Eye tracking can be used to analyse the VA of healthcare providers. No study has examined eye tracking during neonatal resuscitation. OBJECTIVE To test the use of eye tracking to examine VA during neonatal resuscitation. METHODS Six video recordings were obtained using eye tracking glasses worn by resuscitators during the first 5 min of neonatal resuscitation. Videos were analysed to obtain (i) areas of interest (AOIs), (ii) time spent on each AOI and (iii) frequency of saccades between AOIs. RESULTS Five videos were of acceptable quality and analysed. Only 35% of VA was directed at the infant, with 33% at patient monitors and gauges. There were frequent saccades (0.45/s) and most involved patient monitors. CONCLUSION During neonatal resuscitation, VA is often directed away from the infant towards patient monitors. Eye tracking can be used to analyse human performance during neonatal resuscitation.
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Affiliation(s)
- Brenda Hiu Yan Law
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Po-Yin Cheung
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Wagner
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Sylvia van Os
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Georg Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Law BHY, Cheung PY, O’Reilly M, Fray C, Schmölzer G. EFFECT OF EQUIPMENT ORGANIZATION ON NEONATAL RESUSCITATION UNDER SIMULATION CONDITIONS. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Law BHY, Bratu I, Jain V, Landry MA. Refractory tension pneumothorax as a result of an internally displaced thoracoamniotic shunt in an infant with a congenital pulmonary airway malformation. BMJ Case Rep 2016; 2016:bcr-2016-216324. [PMID: 27469386 DOI: 10.1136/bcr-2016-216324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Antenatally, congenital pulmonary airway malformation (CPAM) causing fetal hydrops can be palliated with thoracoamniotic shunts, which may become displaced in utero. We report a case of an infant born at 34 weeks gestational age with an antenatally diagnosed macrocystic lung lesion, fetal hydrops and an internally displaced thoracoamniotic shunt. The infant suffered refractory pneumothoraces despite multiple chest drains, and stabilised only after surgical resection of the lesion. Intraoperatively, the shunt was noted to form a connection between a type I CPAM and the pleural space. As the shunt was displaced internally, this complication was not immediately obvious during the initial resuscitation. In infants with large cystic lung lesions, clinicians should be aware that internally displaced thoracoamniotic shunts could contribute to refractory tension pneumothoraces and anticipate the need for advanced neonatal resuscitation, including early thoracocentesis or chest drain insertion. Furthermore, displaced shunts may require early surgical intervention.
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Affiliation(s)
- Brenda Hiu Yan Law
- Department of Pediatrics, Division of Neonatology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Ioana Bratu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Venu Jain
- Department of Obstetrics Gynecology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Marc-Antoine Landry
- Department of Pediatrics, Division of Neonatology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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