Chest Compressions for Bradycardia during Neonatal Resuscitation—Do We Have Evidence?

Agrawal, Vikash; Lakshminrusimha, Satyanarayana; Chandrasekharan, Praveen

doi:10.3390/children6110119

Cited by 5 publications

(3 citation statements)

References 52 publications

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“…There is also very little evidence from animal studies. 302 Further description is included in the full online CoSTR. 301 e240…”

Section: Summary Of Evidencementioning

confidence: 99%

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

Berg,

Bray,

et al. 2023

Circulation

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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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“…There is also very little evidence from animal studies. 302 Further description is included in the full online CoSTR. 301 e240…”

Section: Summary Of Evidencementioning

confidence: 99%

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

Berg,

Bray,

et al. 2023

Circulation

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“…No study examined different heart rate thresholds to initiate CC in newborn infants in the delivery room. However, we identified a review of strategies to prevent progression of bradycardia and the role of CC for persistent neonatal bradycardia in the delivery room 10…”

Section: Resultsmentioning

confidence: 99%

Chest compressions in newborn infants: a scoping review

Ramachandran

Bruckner

Wyckoff

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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AimThe International Liaison Committee on Resuscitation Neonatal Life Support Task Force undertook a scoping review of the literature to identify evidence relating to neonatal cardiopulmonary resuscitation.MethodsMEDLINE complete, EMBASE and Cochrane database of Systematic reviews were searched from inception to November 2021. Two authors screened titles and abstracts and full text reviewed. Studies were eligible for inclusion if they were peer-reviewed and assessed one of five aspects of chest compression in the newborn infant including: (1) heart rate thresholds to start chest compressions (CC), (2) compression to ventilation ratio (C:V ratio), (3) CC technique, (4) oxygen use during CC and 5) feedback devices to optimise CC.ResultsSeventy-four studies were included (n=46 simulation, n=24 animal and n=4 clinical studies); 22/74 were related to compression to ventilation ratios, 29/74 examined optimal technique to perform CC, 7/74 examined oxygen delivery and 15/74 described feedback devices during neonatal CC.ConclusionThere were very few clinical studies and mostly manikin and animal studies. The findings either reinforced or were insufficient to change previous recommendations which included to start CC if heart rate remains <60/min despite adequate ventilation, using a 3:1 C:V ratio, the two-thumb encircling technique and 100% oxygen during CC.

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“…At birth, the clinical team assesses the infant's heart rate (HR) to guide intervention during neonatal resuscitation (1). If HR is <60/min, chest compressions (CC) must be started (1) Bradycardia and asystole were believed to be the most common cardiac arrest rhythms in newborn infants (2). However, there is a lack of data what HR cut-off to start CC should be used in neonatal patients with bradycardia secondary to asphyxia.…”

Section: Introductionmentioning

confidence: 99%

Return of Spontaneous Circulation Depends on Cardiac Rhythm During Neonatal Cardiac Arrest in Asphyxiated Newborn Animals

et al. 2021

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Objective: Pulseless electrical activity (PEA) occurs in asphyxiated newborn piglets and infants. We aimed to examine whether different cardiac rhythms (asystole, bradycardia, PEA) affects the resuscitation outcomes during continuous chest compressions (CC) during sustained inflations (CC+SI).Design: This study is a secondary analysis of four previous randomized controlled animal trials that compared CC+SI with different CC rate (90 or 120/min), SI duration (20 or 60 s), peak inflation pressure (10, 20, or 30 cmH2O), and oxygen concentration (18, 21, or 100%).Setting and Subjects: Sixty-six newborn mixed breed piglets (1–3 days of age, weight 1.7–2.4 kg) were obtained on the day of experimentation from the University Swine Research Technology Center.Interventions: In all four studies, piglets were randomized into intervention or sham. Piglets randomized to “intervention” underwent both hypoxia and asphyxia, whereas, piglets randomized to “sham” received the same surgical protocol, stabilization, and equivalent experimental periods without hypoxia and asphyxia.Measurements: To compare differences in asphyxiation time, time to return of spontaneous circulation (ROSC), hemodynamics, and survival rate in newborn piglets with asystole, bradycardia or PEA.Main Results: Piglets with PEA (n = 29) and asystole (n = 13) had a significantly longer asphyxiation time and time to ROSC vs. bradycardia (n = 24). Survival rates were similar between all groups. Compared to their baseline, mean arterial pressure and carotid blood flow were significantly lower 4 h after resuscitation in all groups, while being significantly higher in the bradycardia group.Conclusion: This study indicates that cardiac rhythm before resuscitation influences the time to ROSC and hemodynamic recovery after ROSC.

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Chest Compressions for Bradycardia during Neonatal Resuscitation—Do We Have Evidence?

Cited by 5 publications

References 52 publications

Chest compressions in newborn infants: a scoping review

Return of Spontaneous Circulation Depends on Cardiac Rhythm During Neonatal Cardiac Arrest in Asphyxiated Newborn Animals

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