A review of approaches to optimise chest compressions in the resuscitation of asphyxiated newborns

Solevåg, Anne Lee; Cheung, Po-Yin; O’Reilly, Megan; Schmölzer, Georg M.

doi:10.1136/archdischild-2015-309761

Cited by 24 publications

(28 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As indicated in numerous studies involving both children and adults, maintaining adequate CC frequency can be problematic because medical staff tend to perform CCs with too high a rate [18][19][20]. Moreover, the optimal frequency of CCs in both children and adults is not specified [21][22][23]. Li et al [24] showed that even though it was possible for neonatal staff to perform continuous CCs at rates of 90 and 120 × min -1 , a significant decay in CC pressure occurred after 96 s and 72 s, respectively.…”

Section: Discussionmentioning

confidence: 99%

Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial

et al. 2018

View full text Add to dashboard Cite

A b s t r a c tBackground: Early bystander cardiopulmonary resuscitation (CPR) for cardiac arrest is crucial in the chain of survival. Cardiac arrest in infants is rare, but CPR is also performed in severe bradycardia. European Resuscitation Council and American Heart Association guidelines recommend continuing CPR until the heart muscle is sufficiently oxygenated and regains sufficient contractility and function. The most common and recommended CPR techniques that can be applied in newborns are the two-finger technique and two-thumb technique. Aim:We sought to assess the quality of CPR performed in newborns with the two-finger technique depending on the position of the rescuer during resuscitation. Methods:This was a prospective, randomised, crossover, simulated study. It involved 93 nurses who were required to perform a two-minute CPR using the two-finger technique in three scenarios: (A) with the newborn lying on the floor; (B) on a table; and (C) with the newborn on the rescuer's forearm. The Newborn Tory ® S2210 manikin was used to simulate a neonatal patient in cardiac arrest. The following parameters were measured: chest compression (CC) depth, CC rate, no-flow time, percentage of full release, ventilation rate, and ventilation volume, as well as the number of effective compressions and effective ventilations.Results: Statistical analysis showed significant differences in CC rates between scenarios A and B (p < 0.001) and between scenarios B and C (p = 0.002). Significant differences were also observed between the median CC depth. The median percentage of no-flow-fraction was the highest for scenario A (55%), followed by scenario B (48%), and scenario C (46%). There were significant differences between the values of no-flow-fraction between scenarios A and B (p < 0.001), and between scenarios A and C (p < 0.001). The percentage of chest full releases for scenarios A, B, and C amounted to 94%, 1%, and 92%, respectively. Significant differences in the number of effective CCs between scenarios A and B (p < 0.001) as well as B and C (p < 0.001) were revealed. The median ventilation rate was highest for scenario B (13 × min ). The highest tidal volume was obtained in scenario A (27 mL), and the lowest in scenario C (26 mL). The most effective CPR was performed when resuscitation was carried out on the rescuer's forearm. Conclusions:The quality of CCs in newborns depends on the location of the patient and the rescuer. The optimal form of resuscitation of newborns is resuscitation on the rescuer's forearm.

show abstract

Section: Discussionmentioning

confidence: 99%

Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The current neonatal resuscitation guidelines recommend a 3: 1 C:V ratio; however, these recommendations are based on expert opinions, animal data, and consensus rather than strong scientific evidence [6, 19, 20]. Rationales for using a 3: 1 C:V ratio include higher physiological heart rates of 120–160/min and breathing rates of 40–60/min in newborns compared to adults.…”

Section: Discussionmentioning

confidence: 99%

“…Along with high-quality CC, providing ventilation is important during neonatal CPR [19, 26]. Manikin studies reported higher ventilation rates during 3: 1 C:V compared to higher C:V ratios [27, 28].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Compression to Ventilation Ratios (2: 1, 3: 1, and 4: 1) during Cardiopulmonary Resuscitation in a Porcine Model of Neonatal Asphyxia

et al. 2018

Self Cite

View full text Add to dashboard Cite

Background: High-quality chest compression is essential during neonatal cardiopulmonary resuscitation (CPR). However, the optimal compression to ventilation ratio (C:V) that should be used during neonatal CPR to optimize coronary and cerebral perfusion while providing adequate ventilation remains unknown. Objective: We hypothesized that different C:V ratios (e.g., 2: 1 or 4: 1) will reduce the time to return of spontaneous circulation (ROSC) in severely asphyxiated piglets. Methods: Thirty-one newborn piglets (1–4 days old) were anesthetized, intubated, instrumented, and exposed to 50-min normocapnic hypoxia followed by asphyxia. Piglets were randomized into 4 groups: 2: 1 (n = 8), 3: 1 (n = 8), 4: 1 (n = 8) C:V ratio, or a sham group (n = 7). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. Results: Thirty-one piglets were included in the study, and there was no difference in the duration of asphyxia or the degree of asphyxiation (as indicated by pH, PaCO₂, and lactate) among the different groups. The median (IQR) time to ROSC was similar between the groups with 127 (82–210), 96 (88–126), and 119 (83–256) s in the 2: 1, 3: 1, and 4: 1 C:V ratio groups, respectively (p = 0.67 between groups). Similarly, there was no difference in 100% oxygen requirement or epinephrine administration between the experimental groups. Conclusions: Different C:V ratios resulted in similar ROSC, mortality, oxygen, and epinephrine administration during resuscitation in a porcine model of neonatal asphyxia.

show abstract

“…Approximately 0.8% term neonates and up to 10% of preterm neonates require CC at birth . In term infants, these interventions result in approximately 1 million newborn deaths annually worldwide . The current resuscitation techniques, which are revised by the International Liaison Committee On Resuscitation (ILCOR) every 5 years, are based on current understanding and latest evidence .…”

mentioning

confidence: 99%

“…Furthermore, profound bradycardia or cardiac arrest in newborns is usually caused by hypoxia rather than primary cardiac compromise; therefore, providing ventilation is more likely to be beneficial in neonatal CPR compared with adult CPR . Successful resuscitation requires the delivery of high‐quality CC, encompassing several factors including (A) optimal C:V ratio, (B) adequate rate, (C) depth of CC and (D) full recoil between compressions . Although there is an agreement that these factors are all important for a successful resuscitation, neither has been extensively studied to optimise coronary and cerebral perfusion while providing adequate ventilation of an asphyxiated newborn.…”

mentioning

confidence: 99%

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

Schmölzer

2016

Acta Paediatrica

View full text Add to dashboard Cite

A review of approaches to optimise chest compressions in the resuscitation of asphyxiated newborns

Abstract: Successful CPR requires the delivery of high-quality CC, encompassing optimal (A) C:V ratio (B) rate, (C) depth, (D) chest recoil between CC, (E) technique and (F) adrenaline dosage. More animal studies with high translational value and randomised clinical trials are needed.

Cited by 24 publications

References 55 publications

Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial

Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial

Comparison of Different Compression to Ventilation Ratios (2: 1, 3: 1, and 4: 1) during Cardiopulmonary Resuscitation in a Porcine Model of Neonatal Asphyxia

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

Contact Info

Product

Resources

About