Epinephrine Use during Newborn Resuscitation

Kapadia, Vishal; Wyckoff, Myra H.

doi:10.3389/fped.2017.00097

Cited by 28 publications

(25 citation statements)

References 75 publications

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“…Although no studies have examined the optimum timing of adrenaline in the neonatal population, pediatric studies have shown that delay to first adrenaline dose is associated with decreased return of spontaneous circulation and survival (49). Many questions remain to be answered in relation to adrenaline administration (50). Observational studies have shown that in infants requiring adrenaline during resuscitation, only 40% received their first dose within the first 10 min of life, with the median age to first adrenaline dose of 10 min (95% CI 8-14 min) (51).…”

Section: Adrenaline/accessmentioning

confidence: 99%

Simulation in Neonatal Resuscitation

Garvey

Dempsey

2020

Front. Pediatr.

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Approximately 1 in 10 newborns will require basic resuscitation interventions at birth. Some infants progress to require more advanced measures including the provision of positive pressure ventilation, chest compressions, intubation and administration of volume/cardiac medications. Although advanced resuscitation is infrequent, it is crucial that personnel adequately trained in these techniques are available to provide such resuscitative measures. In 2000, Louis Halmalek et al. called for a "New Paradigm in Pediatric Medical Education: Teaching Neonatal Resuscitation in a Simulated Delivery Room Environment." This was one of the first articles to highlight simulation as a method of teaching newborn resuscitation. The last decades have seen an exponential growth in the area of simulation in newborn care, in particular in newborn resuscitation and stabilization. Simulation is best defined as an instructional strategy "used to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner." Simulation training has now become an important point of how we structure training and deliver improved healthcare to patients. Some of the key aspects of simulation training include feedback, deliberate practice, outcome measurement, retention of skills and curriculum integration. The term "Train to win" is often used in sporting parlance to define how great teams succeed. The major difference between sports teams is that generally their game day comes once a week, whereas in newborn resuscitation every day is potentially "game day." In this review we aim to summarize the current evidence on the use of simulation based education and training in neonatal resuscitation, with particular emphasis on the evidence supporting its effectiveness. We will also highlight recent advances in the development of simulation based medical education in the context of newborn resuscitation to ensure we "train to win."

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Section: Adrenaline/accessmentioning

confidence: 99%

Simulation in Neonatal Resuscitation

Garvey

Dempsey

2020

Front. Pediatr.

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“…Further, once CC are given, a vascular access should be established for epinephrine administration 3 . Other than increasing the heart rate, heart contractility, and myocardial relaxation rate via stimulating β-receptors, epinephrine has also been shown to cause vasoconstriction of both peripheral and coronary arteries by activating α-receptors (3,4). However, both the effectiveness and safety for using epinephrine during resuscitation are still debatable (3)(4)(5).…”

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confidence: 99%

Effects of epinephrine on hemodynamic changes during cardiopulmonary resuscitation in a neonatal piglet model

Wagner

Cheung

et al. 2018

Pediatr Res

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BackgroundAsphyxia is the most common reason for newborns to fail to make a successful fetal-to-neonatal transition. There is currently a lack of data evaluating hemodynamic effects of epinephrine during neonatal cardiopulmonary resuscitation.MethodsTwenty-four newborn piglets were exposed to asphyxia. Thereafter, positive pressure ventilation was commenced for 30 s, followed by chest compressions (CC). Piglets were randomized into three experimental groups: 3:1 compression:ventilation ratio; CC during sustained inflation (SI) at a rate of 90 CC per minute, or CC during SI at a rate of 120 CC per minute. Epinephrine (0.01 mg/kg per dose) was administered to a maximum of four doses. Hemodynamic parameters were measured throughout the experiment.ResultsAnimals were divided into survivors and nonsurvivors. End-diastolic and developed pressures declined after epinephrine administration in the survivor group. dp/dt min was significantly higher in the survivor group whereas dp/dt max showed no significant differences. Epinephrine had no effect on either heart rate or cardiac output in both groups. Ejection fraction increased after epinephrine with no significant difference between groups.ConclusionEpinephrine did not affect survival rates or return of spontaneous circulation in our postnatal porcine model of neonatal asphyxia.

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“…We followed a protocol and were able to reproduce severe asphyxia with very similar degrees of acidosis and hypoxemia in both study groups, confirming that this model is quite stable. We followed closely the published resuscitation guidelines and used epinephrine before volume expansion and all animals received at least one dose of epinephrine, which, because of its positive effect on coronary blood flow, is considered to be important for successful resuscitation ( 24 ). Volume depletion was approximately 1/3 of the estimated blood volume.…”

Section: Discussionmentioning

confidence: 99%

Successful Resuscitation in a Model of Asphyxia and Hemorrhage to Test Different Volume Resuscitation Strategies. A Study in Newborn Piglets After Transition

et al. 2018

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Background: Evidence for recommendations on the use of volume expansion during cardiopulmonary resuscitation in newborn infants is limited.Objectives: To develop a newborn piglet model with asphyxia, hemorrhage, and cardiac arrest to test different volume resuscitation on return of spontaneous circulation (ROSC). We hypothesized that immediate red cell transfusion reduces time to ROSC as compared to the use of an isotonic crystalloid fluid.Methods: Forty-four anaesthetized and intubated newborn piglets [age 32 h (12–44 h), weight 1,220 g (1,060–1,495g), Median (IQR)] were exposed to hypoxia and blood loss until asystole occurred. At this point they were randomized into two groups: (1) Crystalloid group: receiving isotonic sodium chloride (n = 22). (2) Early transfusion group: receiving blood transfusion (n = 22). In all other ways the piglets were resuscitated according to ILCOR 2015 guidelines [including respiratory support, chest compressions (CC) and epinephrine use]. One hour after ROSC piglets from the crystalloid group were randomized in two sub-groups: late blood transfusion and infusion of isotonic sodium chloride to investigate the effects of a late transfusion on hemodynamic parameters.Results: All animals achieved ROSC. Comparing the crystalloid to early blood transfusion group blood loss was 30.7 ml/kg (22.3–39.6 ml/kg) vs. 34.6 ml/kg (25.2–44.7 ml/kg), Median (IQR). Eleven subjects did not receive volume expansion as ROSC occurred rapidly. Thirty-three animals received volume expansion (16 vs. 17 in the crystalloid vs. early transfusion group). 14.1% vs. 10.5% of previously extracted blood volume in the crystalloid vs. early transfusion group was infused before ROSC. There was no significant difference in time to ROSC between groups [crystalloid group: 164 s (129–198 s), early transfusion group: 163 s (162–199 s), Median (IQR)] with no difference in epinephrine use.Conclusions: Early blood transfusion compared to crystalloid did not reduce time to ROSC, although our model included only a moderate degree of hemorrhage and ROSC occurred early in 11 subjects before any volume resuscitation occurred.

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Epinephrine Use during Newborn Resuscitation

Cited by 28 publications

References 75 publications

Simulation in Neonatal Resuscitation

Simulation in Neonatal Resuscitation

Effects of epinephrine on hemodynamic changes during cardiopulmonary resuscitation in a neonatal piglet model

Successful Resuscitation in a Model of Asphyxia and Hemorrhage to Test Different Volume Resuscitation Strategies. A Study in Newborn Piglets After Transition

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