Neonatal Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Wyckoff, Myra H.; Wyllie, Jonathan; Aziz, Khalid; Almeida, Maria Fernanda de; Fabres, Jorge; Fawke, Joe; Guinsburg, Ruth; Hosono, Shigeharu; Isayama, Tetsuya; Kapadia, Vishal; Kim, Han-Suk; Liley, Helen; McKinlay, Christopher J.D.; Mildenhall, Lindsay; Perlman, Jeffrey M.; Rabi, Yacov; Roehr, Charles Christoph; Schmölzer, Georg M.; Szyld, Edgardo; Trevisanuto, Daniele; Velaphi, Sithembiso; Weiner, Gary M.; Davis, Peter G; Dawson, Jennifer; Ersdal, Hege; Foglia, Elizabeth E.; Kawakami, Mandira Daripa; Lee, Henry; Rüdiger, Mario; Sawyer, Taylor; Soraisham, Amouchou; Strand, Marya; Udaeta, Enrique; Urlesburger, Berndt; Yamada, Nicole K.; Madar, John; Escobedo, Marilyn; Ganguly, Abhrajit; Gately, Callum; Kamath‐Rayne, Beena D.; Mausling, Richard; Domingo-Bates, Jocelyn; Nakwa, Firdose; Ramachandran, Shalini; Ring, Jenny; Shah, Birju A.; Stave, Christopher D; Tamura, Masanori; Pas, Arjan B. te

doi:10.1016/j.resuscitation.2020.09.015

Cited by 111 publications

(173 citation statements)

References 143 publications

(176 reference statements)

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“…However, in 2010 ‘justifiable’ to stop was changed to ‘appropriate’, and in 2015 to ‘reasonable’. This contrasts with the new recommendations arguing that a reasonable timeframe to consider before ending resuscitation ‘is around’ 20 min after birth 1–5 …”

Section: Discussionmentioning

confidence: 92%

“…If intravascular access is not yet available, administering endotracheal epinephrine (adrenaline) at a larger dose (0.05-0.1 mg/kg) than the dose used for intravenous administration is suggested. 5. Umbilical venous catheterisation is suggested as the primary method of vascular access during newborn infant resuscitation in the delivery room.…”

Section: For Non-vigorous Newborn Infants Delivered Through Meco-mentioning

confidence: 99%

“…In addition, knowledge gaps are summarised. 5 Three types of evidence evaluation, systematic reviews, scoping review and evidence update, support the 2020 recommendations.…”

Section: Introductionmentioning

confidence: 96%

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A critical review of the 2020 International Liaison Committee on Resuscitation treatment recommendations for resuscitating the newly born infant

2021

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The 2020 recommendations from the International Liaison Committee on Resuscitation are an improved version of the 2015 version. The algorithm and 15 procedures are unchanged from 2015, but there are six procedures with new or changed recommendations. One new recommendation is briefing/debriefing following neonatal resuscitation. Procedures with changed suggestions/recommendations are as follows: suctioning of non‐vigorous infants delivered through meconium‐stained amniotic fluid, sustained inflation of preterm infants, optimising epinephrine (adrenaline), vascular access and discontinuing resuscitative efforts. Conclusion In this review, we summarise the present recommendations and offer additional comments and views regarding heart rate detection, cord clamping, oxygenation and thermal control.

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Section: Discussionmentioning

confidence: 92%

Section: For Non-vigorous Newborn Infants Delivered Through Meco-mentioning

confidence: 99%

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A critical review of the 2020 International Liaison Committee on Resuscitation treatment recommendations for resuscitating the newly born infant

2021

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“…Even though the male disadvantage is reported by many studies in newborn humans and animals, we have previously shown no difference between male and female newborn piglets during hypoxia, asphyxia, resuscitation, and post-resuscitation recovery (14). Current resuscitation guidelines recommend performing chest compressions (CC) at a rate of 90/min with 30 ventilations (3:1 C:V) to achieve adequate oxygen delivery (15)(16)(17). Apart from current recommendations, several interventions, namely CC with asynchronous ventilations (CCaV) and sustained inflation during chest compression (CC+SI), have also been shown to be effective during cardiopulmonary resuscitation (18,19).…”

Section: Introductionmentioning

confidence: 92%

Asphyxiated Female and Male Newborn Piglets Have Similar Outcomes With Different Cardiopulmonary Resuscitation Interventions

et al. 2020

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Background: Male newborns have a greater risk of poor cardiovascular and respiratory outcomes compared to females. The mechanisms associated with the “male disadvantage” remains unclear. We have previously shown no difference between male and female newborn piglets during hypoxia, asphyxia, resuscitation, and post-resuscitation recovery. However, it is unknown if there are differences in resuscitation outcomes between males and females during different cardiopulmonary resuscitation techniques.Intervention and Measurements: Secondary analysis of 184 term newborn mixed breed duroc piglets (1–3 days of age, weighing 2.0 (0.2) kg) from seven different studies, which were exposed to 30–50 min of normocapnic hypoxia followed by asphyxia until asystole. This was followed by cardiopulmonary resuscitation. For the analysis, piglets were divided into male and female groups, as well as resuscitation technique groups (sustained inflation, 3:1 compression-to-ventilation ratio, or asynchronous ventilations during chest compressions). Cardiac function, carotid blood flow, and cerebral oxygenation were continuously recorded throughout the experiment.Main results: Regardless of resuscitation technique, there was no significant difference between males and females in the number achieving return of spontaneous circulation (ROSC) [95/123 (77%) vs. 48/61 (79%)], the time to achieve ROSC [112 (80–185) s vs. 110 (77–186) s], and the 4-h survival rate [81/95 (85%) vs. 40/48 (83%)]. Levels of the injury markers interleukin (IL)−1ß, IL-6, IL-8, and tumor necrosis factor-α in frontoparietal cortex tissue homogenates were similar between males and females.Conclusions: Regardless of resuscitation technique, there was no significant effect of sex on resuscitation outcome, survival, and hemodynamic recovery in asphyxiated newborn piglets.

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“…Currently, epinephrine is the only medication recommended in neonatal resuscitation 1 and is indicated if the heart rate remains below 60 beats per minute (bpm) despite effective positive pressure ventilation (PPV) with 100% O 2 and chest compressions (CC). 2 3 Time to return of spontaneous circulation (ROSC) is an important prognostic indicator of outcome.…”

Section: Introductionmentioning

confidence: 99%

Randomised trial of epinephrine dose and flush volume in term newborn lambs

Sankaran

Chandrasekharan

Gugino

et al. 2021

Arch Dis Child Fetal Neonatal Ed

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ObjectivesNeonatal resuscitation guidelines recommend 0.5–1 mL saline flush following 0.01–0.03 mg/kg of epinephrine via low umbilical venous catheter for persistent bradycardia despite effective positive pressure ventilation (PPV) and chest compressions (CC). We evaluated the effects of 1 mL vs 3 mL/kg flush volumes and 0.01 vs 0.03 mg/kg doses on return of spontaneous circulation (ROSC) and epinephrine pharmacokinetics in lambs with cardiac arrest.DesignForty term lambs in cardiac arrest were randomised to receive 0.01 or 0.03 mg/kg epinephrine followed by 1 mL or 3 mL/kg flush after effective PPV and CC. Epinephrine (with 1 mL flush) was repeated every 3 min until ROSC or until 20 min. Haemodynamics, blood gases and plasma epinephrine concentrations were monitored.ResultsTen lambs had ROSC before epinephrine administration and 2 died during instrumentation. Among 28 lambs that received epinephrine, 2/6 in 0.01 mg/kg-1 mL flush, 3/6 in 0.01 mg/kg-3 mL/kg flush, 5/7 in 0.03 mg/kg-1 mL flush and 9/9 in 0.03 mg/kg-3 mL/kg flush achieved ROSC (p=0.02). ROSC was five times faster with 0.03 mg/kg epinephrine compared with 0.01 mg/kg (adjusted HR (95% CI) 5.08 (1.7 to 15.25)) and three times faster with 3 mL/kg flush compared with 1 mL flush (3.5 (1.27 to 9.71)). Plasma epinephrine concentrations were higher with 0.01 mg/kg-3 mL/kg flush (adjusted geometric mean ratio 6.0 (1.4 to 25.7)), 0.03 mg/kg-1 mL flush (11.3 (2.1 to 60.3)) and 0.03 mg/kg-3 mL/kg flush (11.0 (2.2 to 55.3)) compared with 0.01 mg/kg-1 mL flush.Conclusions0.03 mg/kg epinephrine dose with 3 mL/kg flush volume is associated with the highest ROSC rate, increases peak plasma epinephrine concentrations and hastens time to ROSC. Clinical trials evaluating optimal epinephrine dose and flush volume are warranted.

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Neonatal Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Cited by 111 publications

References 143 publications

A critical review of the 2020 International Liaison Committee on Resuscitation treatment recommendations for resuscitating the newly born infant

A critical review of the 2020 International Liaison Committee on Resuscitation treatment recommendations for resuscitating the newly born infant

Asphyxiated Female and Male Newborn Piglets Have Similar Outcomes With Different Cardiopulmonary Resuscitation Interventions

Randomised trial of epinephrine dose and flush volume in term newborn lambs

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