Pulseless electrical activity: a misdiagnosed entity during asphyxia in newborn infants?

Patel, Sparsh; Cheung, Po–Yin; Solevåg, Anne Lee; Barrington, Keith J.; Kamlin, C. Omar F.; Davis, Peter G; Schmölzer, Georg M.

doi:10.1136/archdischild-2018-314907

Cited by 31 publications

(32 citation statements)

References 7 publications

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“…This cardiac electrical activity in the absence of pulse is called cardiac arrest with pulseless electrical activity, a preterminal rhythm which has been observed following severe asphyxiation. 29 In this study, bradycardia was confirmed with auscultation, and no pulseless electrical activity was encountered. Our data support that pulseless electrical activity is likely to be uncommon in neonates at delivery.…”

Section: Discussionmentioning

confidence: 52%

Impact of electronic cardiac (ECG) monitoring on delivery room resuscitation and neonatal outcomes

et al. 2019

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Aim: In 2016, the neonatal resuscitation guidelines suggested electronic cardiac (ECG) monitoring to assess heart rate for an infant receiving positive pressure ventilation immediately after birth. Our aim was to study the impact of ECG monitoring on delivery room resuscitation interventions and neonatal outcomes.Methods: Observational cohort study compared maternal, perinatal and infant characteristics, before (retrospective cohort, calendar year 2015) and after (prospective cohort, calendar year 2017) implementation of ECG monitoring in the delivery room. Association of ECG monitoring with delivery room resuscitation practice interventions and neonatal outcomes was assessed using unadjusted and adjusted multivariable regression analyses.Results: Of 632 newly born infants who received positive pressure ventilation in the delivery room, ECG monitoring was performed in 369 (the prospective cohort) compared with no ECG monitoring in 263 (the retrospective cohort). Compared to neonates in the retrospective cohort, neonates with ECG monitoring had a significantly lower endotracheal intubation rate (36% vs 48%, P < .005) in the delivery room and higher 5-min Apgar scores (7 [5-8] vs 6 [5-8], P < .05). There was no difference in mortality (31 [8%] vs 23 [9%]), but infants who received ECG monitoring had increased odds of receiving chest compressions with an adjusted odds ratio of 3.6 (95% confidence interval: 1.4-9.5).Conclusion: Introduction of ECG monitoring in the delivery room was associated with fewer endotracheal intubations, and an increase use of chest compressions with no difference in mortality.

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Section: Discussionmentioning

confidence: 52%

Impact of electronic cardiac (ECG) monitoring on delivery room resuscitation and neonatal outcomes

et al. 2019

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“…The study by Patel et al [6] and our clinical experience described in this report suggest that a high index of suspicion may be warranted during resuscitation of infants following severe asphyxia or other extensive perinatal insults. Integrating physical examination findings and the pulse oximeter output, specifically the absence of a pulsatile waveform, may help clinicians quickly identify PEA.…”

Section: Discussionmentioning

confidence: 98%

“…In contrast, PEA is believed to be an unusual occurrence in neonatal resuscitation, though diagnosis relies on use of ECG and a precise incidence has never been reported in this population. Recent animal data by Patel et al [6] identified PEA in nearly half of neonatal piglets following prolonged asphyxia. This finding suggests that PEA may be relatively frequent in asphyxiated newborns, such as the infant described in our case, but has been undetected prior to widespread adoption of ECG in the delivery room setting.…”

Section: Discussionmentioning

confidence: 99%

Pulseless Electrical Activity Complicating Neonatal Resuscitation

et al. 2018

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Background: The most recent guidelines by the Neonatal Resuscitation Program recommend use of electrocardiography monitoring during advanced resuscitation. Objective: We describe a case in whom detection of pulseless electrical activity (PEA) on electronic heart rate monitoring complicated delivery room management of an extremely low birth weight infant and offer suggestions for the identification of PEA for neonatal providers. Conclusion: Further prospective studies are needed to determine the true incidence of PEA in the delivery room setting as well as its prognosis in newborns.

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“…There is increasing evidence that PEA occurs in the delivery room [15]. Two studies report that the ECG displayed a HR during PEA in 40-50% of asphyxiated newborn piglets [48,49]. There have been one case report and a case series totaling seven cases of PEA in the delivery room during neonatal resuscitation [50][51][52][53].…”

Section: Pulseless Electrical Activitymentioning

confidence: 99%

Heart Rate Assessment during Neonatal Resuscitation

Johnson

Schmölzer

2020

Healthcare

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Approximately 10% of newborn infants require some form of respiratory support to successfully complete the fetal-to-neonatal transition. Heart rate (HR) determination is essential at birth to assess a newborn’s wellbeing. Not only is it the most sensitive indicator to guide interventions during neonatal resuscitation, it is also valuable for assessing the infant’s clinical status. As such, HR assessment is a key step at birth and throughout resuscitation, according to recommendations by the Neonatal Resuscitation Program algorithm. It is essential that HR is accurate, reliable, and fast to ensure interventions are delivered without delay and not prolonged. Ineffective HR assessment significantly increases the risk of hypoxic injury and infant mortality. The aims of this review are to summarize current practice, recommended techniques, novel technologies, and considerations for HR assessment during neonatal resuscitation at birth.

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Pulseless electrical activity: a misdiagnosed entity during asphyxia in newborn infants?

Abstract: Clinicians should be aware of the potential inaccuracy of ECG assessment during asphyxia in newborn infants and should rather rely on assessment using a combination of auscultation, palpation, pulse oximetry and ECG.

Cited by 31 publications

References 7 publications

Impact of electronic cardiac (ECG) monitoring on delivery room resuscitation and neonatal outcomes

Impact of electronic cardiac (ECG) monitoring on delivery room resuscitation and neonatal outcomes

Pulseless Electrical Activity Complicating Neonatal Resuscitation

Heart Rate Assessment during Neonatal Resuscitation

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