scholarly journals Is Chest Compression Superimposed with Sustained Inflation during Cardiopulmonary Resuscitation an Alternative to 3:1 Compression to Ventilation Ratio in Newborn Infants?

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 97
Author(s):  
Seung Yeon Kim ◽  
Gyu-Hong Shim ◽  
Georg M. Schmölzer
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Spontaneous Circulation ◽  
Delivery Room ◽  
Sustained Inflation ◽  
Resuscitation Guidelines ◽  
High Incidence ◽  
Reduced Time

Approximately 0.1% for term and 10–15% of preterm infants receive chest compression (CC) in the delivery room, with high incidence of mortality and neurologic impairment. The poor prognosis associated with receiving CC in the delivery room has raised concerns as to whether specifically-tailored cardiopulmonary resuscitation methods are needed. The current neonatal resuscitation guidelines recommend a 3:1 compression:ventilation ratio; however, the most effective approach to deliver chest compression is unknown. We recently demonstrated that providing continuous chest compression superimposed with a high distending pressure or sustained inflation significantly reduced time to return of spontaneous circulation and mortality while improving respiratory and cardiovascular parameters in asphyxiated piglet and newborn infants. This review summarizes the current available evidence of continuous chest compression superimposed with a sustained inflation.

scholarly journals Chest Compressions in the Delivery Room

Children ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. 4 ◽  
Author(s):  
Catalina Garcia-Hidalgo ◽  
Georg M. Schmölzer
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Mode Of Action ◽  
Poor Prognosis ◽  
Delivery Room ◽  
Chest Compressions ◽  
Optimal Depth ◽  
The Poor ◽  
Sustained Inflation ◽  
High Incidence

Annually, an estimated 13–26 million newborns need respiratory support and 2–3 million newborns need extensive resuscitation, defined as chest compression and 100% oxygen with or without epinephrine in the delivery room. Despite such care, there is a high incidence of mortality and neurologic morbidity. The poor prognosis associated with receiving chest compression alone or with medications in the delivery room raises questions as to whether improved cardiopulmonary resuscitation methods specifically tailored to the newborn could improve outcomes. This review discusses the current recommendations, mode of action, different compression to ventilation ratios, continuous chest compression with asynchronous ventilations, chest compression and sustained inflation optimal depth, and oxygen concentration during cardiopulmonary resuscitation.

scholarly journals Chest Compressions in the Delivery Room

2018 ◽  
Author(s):  
Catalina Garcia-Hidalgo ◽  
Georg M. Schmölzer
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Poor Prognosis ◽  
Delivery Room ◽  
Chest Compressions ◽  
Short Term ◽  
Optimal Depth ◽  
The Poor ◽  
Sustained Inflation ◽  
High Incidence

Annually, an estimated 13-26 million newborns need respiratory support and 2-3 million newborns need extensive resuscitation, defined as chest compression and 100% oxygen with or without epinephrine in the delivery room. Despite such care, there is a high incidence of mortality and short-term neurologic morbidity. The poor prognosis associated with receiving chest compression alone or with medications in the delivery room raises questions as to whether improved cardiopulmonary resuscitation methods specifically tailored to the newborn could improve outcomes. This review discusses the current recommendations, mode of action, different compression to ventilation ratio, continuous chest compression with asynchronous ventilations, chest compression and sustained inflation optimal depth, and oxygen concentration during cardiopulmonary resuscitation.

Chest compression during sustained inflation versus 3:1 chest compression:ventilation ratio during neonatal cardiopulmonary resuscitation: a randomised feasibility trial

2017 ◽  
Vol 103 (5) ◽  
pp. F455-F460 ◽  
Author(s):  
Georg M Schmölzer ◽  
Megan O Reilly ◽  
Caroline Fray ◽  
Sylvia van Os ◽  
Po-Yin Cheung
Keyword(s):  
Animal Studies ◽  
Neonatal Resuscitation ◽  
Spontaneous Circulation ◽  
Delivery Room ◽  
Feasibility Trial ◽  
Treatment Allocation ◽  
Sustained Inflation ◽  
Resuscitation Guidelines ◽  
Registration Number ◽  
Group A

BackgroundCurrent neonatal resuscitation guidelines recommend 3:1 compression:ventilation (C:V) ratio. Recently, animal studies reported that continuous chest compressions (CC) during a sustained inflation (SI) significantly improved return of spontaneous circulation (ROSC). The approach of CC during SI (CC+SI) has not been examined in the delivery room during neonatal resuscitation.HypothesisIt is a feasibility study to compare CC+SI versus 3:1 C:V ratio during neonatal resuscitation in the delivery room. We hypothesised that during neonatal resuscitation, CC+SI will reduce the time to ROSC. Our aim was to examine if CC+SI reduces ROSC compared with 3:1 C:V CPR in preterm infants <33 weeks of gestation.Study designRandomised feasibility trial.MethodOnce CC was indicated all eligible infants were immediately and randomly allocated to either CC+SI group or 3:1 C:V group. A sequentially numbered, brown, sealed envelope contained a folded card box with the treatment allocation was opened by the clinical team at the start of CC.Study interventionsInfants in the CC+SI group received CC at a rate of 90/min during an SI with a duration of 20 s (CC+SI). After 20 s, the SI was interrupted for 1 s and the next SI was started for another 20 s until ROSC. Infants in the ‘3:1 group’ received CC using 3:1 C:V ratio until ROSC.Primary outcomeOverall the mean (SD) time to ROSC was significantly shorter in the CC+SI group with 31 (9) s compared with 138 (72) s in the 3:1 C:V group (p=0.011).ConclusionCC+SI is feasible in the delivery room.Trial registration numberClinicaltrials.gov NCT02083705, pre-results.

scholarly journals Delivery Room Management of Asphyxiated Term and Near-Term Infants

Neonatology ◽  
2021 ◽  
pp. 1-13
Author(s):  
Marlies Bruckner ◽  
Gianluca Lista ◽  
Ola D. Saugstad ◽  
Georg M. Schmölzer
Keyword(s):  
Preterm Infants ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Birth Asphyxia ◽  
Delivery Room ◽  
Temperature Management ◽  
Term Infants ◽  
Term Newborn ◽  
Resuscitation Guidelines ◽  
Delivery Room Management

Approximately 800,000 newborns die annually due to birth asphyxia. The resuscitation of asphyxiated term newly born infants often occurs unexpected and is challenging for healthcare providers as it demands experience and knowledge in neonatal resuscitation. Current neonatal resuscitation guidelines often focus on resuscitation of extremely and/or very preterm infants; however, the recommendations for asphyxiated term newborn infants differ in some aspects to those for preterm infants (i.e., respiratory support, supplemental oxygen, and temperature management). Since the update of the neonatal resuscitation guidelines in 2015, several studies examining various resuscitation approaches to improve the outcome of asphyxiated infants have been published. In this review, we discuss current recommendations and recent findings and provide an overview of delivery room management of asphyxiated term newborn infants.

scholarly journals Effects of sustained inflation pressure during neonatal cardiopulmonary resuscitation of asphyxiated piglets

2020 ◽  
Author(s):  
Gyu-Hong Shim ◽  
Seung Yeon Kim ◽  
Po-Yin Cheung ◽  
Tze-Fun Lee ◽  
Megan O’Reilly ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Cerebral Oxygenation ◽  
Neonatal Resuscitation ◽  
Spontaneous Circulation ◽  
Control Group ◽  
Inflation Pressure ◽  
Similar Time ◽  
Newborn Piglets ◽  
Arterial Blood ◽  
Sustained Inflation

AbstractObjectiveSustained inflation (SI) during chest compression (CC = CC+SI) significantly reduces time to return of spontaneous circulation (ROSC) compared to 3:1 compression-to-ventilation ratio during neonatal resuscitation. However, the optimal peak inflation pressure (PIP) of SI during CC+SI to improve ROSC and hemodynamic recovery in severely asphyxiated piglets is unknown.AimTo examine if different PIPs of SI during CC+SI will improve ROSC and hemodynamic recovery in severely asphyxiated piglets.Intervention and measurementsTwenty-nine newborn piglets (1-3 days old) were anesthetized, intubated, instrumented and exposed to 30-min normocapnic hypoxia followed by asphyxia. Piglets were randomized into four groups: CC+SI with a PIP of 10 cmH2O (CC+SI_PIP_10, n=8), a PIP of 20 cmH2O (CC+SI_PIP_20, n=8), a PIP of 30 cmH2O (CC+SI_PIP_30, n=8), and a sham-operated control group (n=5). Heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment.Main resultsBaseline parameters were similar between all groups. There was no difference in asphyxiation (duration and degree) between intervention groups. PIP correlated positively with tidal volume and inversely with exhaled CO2 during cardiopulmonary resuscitation. Time to ROSC and rate of ROSC were similar between piglets resuscitated with CC+SI_PIP_10, CC+SI_PIP_20, and CC+SI_PIP_30 cmH2O: median (IQR) 75 (63-193) sec, 94 (78-210) sec, and 85 (70-90) sec; 5/8 (63%), 7/8 (88%), and 3/8 (38%) (p=0.56 and p=0.12, respectively). All piglets that achieved ROSC survived to four hours post-resuscitation. Piglets resuscitated with CC+SI_PIP_30 cmH2O exhibited increased concentrations of pro-inflammatory cytokines interleukin-1β and tumour necrosis factor-α in the frontoparietal cerebral cortex (both p<0.05 vs. sham-operated controls).ConclusionsIn asphyxiated term newborn piglets resuscitated by CC+SI, the use of different PIPs resulted in similar time to ROSC, but PIP at 30 cmH2O showed a larger VT delivery, lower exhaled CO2 and increased tissue inflammatory markers in the brain.

scholarly journals Cardiac arrest with pulseless electrical activity rhythm in newborn infants: a case series

2019 ◽  
Vol 104 (6) ◽  
pp. F572-F574 ◽  
Author(s):  
Deandra Luong ◽  
Po-Yin Cheung ◽  
Keith J Barrington ◽  
Peter G Davis ◽  
Jennifer Unrau ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiopulmonary Resuscitation ◽  
Electrical Activity ◽  
Activity Rhythm ◽  
Healthcare Providers ◽  
Newborn Infants ◽  
Case Series ◽  
Neonatal Resuscitation ◽  
Pulseless Electrical Activity ◽  
Resuscitation Guidelines

The 2015 neonatal resuscitation guidelines added ECG to assess an infant’s heart rate when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room. We report four cases of pulseless electrical activity during neonatal cardiopulmonary resuscitation in levels II–III neonatal intensive care units in Canada (Edmonton [n=3] and Winnipeg [n=1]).Healthcare providers should be aware that pulseless electrical activity can occur in newborn infants during cardiopulmonary resuscitation. We propose an adapted neonatal resuscitation algorithm to include pulseless electrical activity. Furthermore, in compromised newborns, heart rate should be assessed using a combination of methods/techniques to ensure accurate heart rate assessment. When ECG displays a heart rate but the infant is unresponsive, pulseless electrical activity should be suspected and chest compression should be started.

scholarly journals L,Varying Chest Compression Rates During Neonatal Cardiopulmonary Resuscitation: A Randomized Controlled Animal Trial

2021 ◽  
Author(s):  
Marlies Bruckner ◽  
Mattias Neset BSc ◽  
Catalina Garcia-Hidalgo ◽  
Tze-Fun Lee ◽  
Megan O'Reilly ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Contractile Function ◽  
Minute Ventilation ◽  
Neonatal Resuscitation ◽  
Spontaneous Circulation ◽  
Left Ventricular ◽  
Newborn Piglets ◽  
End Diastolic Volume ◽  
Respiratory Parameters

Abstract Background To compare chest compression (CC) rates of 90/min with 180/min and their effect on the time to return of spontaneous circulation (ROSC), survival, hemodynamic, and respiratory parameters. We hypothesized that asphyxiated newborn piglets that received CC at 180/min vs. 90/min during cardiopulmonary resuscitation would have a shorter time to ROSC.Methods Newborn piglets (n=7/group) were anesthetized, intubated, instrumented and exposed to 45 min normocapnic hypoxia followed by asphyxia and cardiac arrest. Piglets were randomly allocated to a CC rate of 180/min or 90/min. CC was performed using an automated chest compression machine. Hemodynamic and respiratory parameters and applied compression force were continuously measured.Results The mean (SD) time to ROSC was 91 (34) and 256 (97) sec for CC rates of 180/min and 90/min, respectively (p=0.08). The number of piglets that achieved ROSC was 7 (100%) and 5 (71%) with 180/min and 90/min CC rates, respectively (p=0.46). Hemodynamic parameters (i.e., diastolic and mean blood pressure, carotid blood flow, stroke volume, end-diastolic volume, left ventricular contractile function) and respiratory parameters (i.e., minute ventilation, peak inflation and peak expiration flow) were all improved with a CC rate of 180/min.Conclusion Time to ROSC and hemodynamic and respiratory parameters were all improved, with a CC rate of 180/min vs. 90/min. Higher CC rates during neonatal resuscitation warrant further investigation.

Abstract 20: Peripheral Intravenous Analysis Detects Return of Spontaneous Circulation Without Interruption of Chest Compressions in a Rat Model of Cardiopulmonary Resuscitation

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Claudius Balzer ◽  
Franz J Baudenbacher ◽  
Antonio Hernandez ◽  
Michele M Salzman ◽  
Matthias L Riess ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Venous Pressure ◽  
Fold Increase ◽  
Spontaneous Circulation ◽  
Arterial Line ◽  
Chest Compressions ◽  
Waveform Data ◽  
Return Of Spontaneous Circulation

Introduction: A higher chest compression fraction (CCF) or percentage of time providing chest compressions is associated with improved survival after cardiac arrest (CA). Pauses in chest compression duration during cardiopulmonary resuscitation (CPR) to palpate a pulse can reduce the CCF. Peripheral Intravenous Analysis (PIVA) is a novel method for determining cardiac and volume status using waveforms from a standard peripheral intravenous (IV) line. We hypothesize that PIVA will demonstrate the onset of return of spontaneous circulation (ROSC) without interruption of CPR. Methods: Eight Zucker Diabetic Fatty (ZDF) rats (4 lean, 4 diabetic) were intubated, ventilated, and cannulated with a 24g IV in the tail vein and a 22g IV in the femoral artery, each connected to a TruWave pressure transducer. Mechanical ventilation was discontinued to achieve CA. After 8 minutes, CPR began with mechanical ventilation, IV epinephrine, and chest compressions using 1.5 cm at 200 times per minute until mean arterial pressure (MAP) increased to 120 mmHg per arterial line. All waveforms were recorded and analyzed in LabChart. PIVA was measured using a Fourier transform of the peripheral venous waveform. Data are mean ± SD. Statistics: Unpaired student’s t-test (two-tailed), α = 05. Results: CA and ROSC were achieved in all 8 rats. Within 1 minute of CPR, there was a 70 ± 35 fold increase/decrease in PIVA during CPR that was temporally associated with ROSC. Within 8 ± 13 seconds of a reduction in PIVA, there was a rapid increase in end-tidal CO 2 . In all rats, ROSC occurred within 38 ± 9 seconds of the maximum PIVA value. Peripheral venous pressure decreased by 1.2 ± 0.9 mmHg during resuscitation and ROSC, which was not significant different at p=0.05. Conclusion: In this pilot study, PIVA detected ROSC without interrupting CPR. Use of PIVA may obviate the need pause CPR for pulse checks, and may result in a higher CCF and survival. Future studies will focus on PIVA and CPR efficacy.

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

2018 ◽  
Vol 104 (2) ◽  
pp. F215-F217 ◽  
Author(s):  
Sparsh Patel ◽  
Po-Yin Cheung ◽  
Anne Lee Solevåg ◽  
Keith J Barrington ◽  
C Omar Farouk Kamlin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Pulseless Electrical Activity ◽  
Heart Sounds ◽  
Carotid Blood Flow ◽  
Neonatal Piglets ◽  
Resuscitation Guidelines ◽  
Recent Case Report ◽  
The Right

BackgroundThe 2015 neonatal resuscitation guidelines added ECG as a recommended method of assessment of an infant’s heart rate (HR) when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room.ObjectivesTo compare accuracy of ECG with auscultation to assess asystole in asphyxiated piglets.MethodsNeonatal piglets had the right common carotid artery exposed and enclosed with a real-time ultrasonic flow probe and HR was continuously measured and recorded using ECG. This set-up allowed simultaneous monitoring of HR via ECG and carotid blood flow (CBF). The piglets were exposed to 30 min normocapnic alveolar hypoxia followed by asphyxia until asystole, achieved by disconnecting the ventilator and clamping the endotracheal tube. Asystole was defined as zero carotid blood flow and was compared with ECG traces and auscultation for heart sounds using a neonatal/infant stethoscope.ResultsOverall, 54 piglets were studied with a median (IQR) duration of asphyxia of 325 (200-491) s. In 14 (26%) piglets, CBF, ECG and auscultation identified asystole. In 23 (43%) piglets, we observed no CBF and no audible heart sounds, while ECG displayed an HR ranging from 15 to 80/min. Sixteen (30%) piglets remained bradycardic (defined as HR of <100/min) after 10 min of asphyxia, identified by CBF, ECG and auscultation.ConclusionClinicians 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.

Sign in / Sign up

Export Citation Format

Share Document