Recent discussions
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Charlotte Cornelis
Is there any literature about rhythm analysis during transport? Is there a statement about whether or not to shock patients during transportation? -
Christopher Cox
Recommending a T-piece resuscitator over a BVM is not unexpected. T-piece resuscitators limit peak inspiratory pressures and provides consistent CPAP as long a seal is kept on the face. . The majority of the weak evidence appears to support this thought as well. It is very easy to over ventilate and induce lung injury with a BVM. Thanks for sharing. -
Michael Malloy
What about a recommendation about delayed cord clamping between 30-60 seconds rather than >= 60 seconds. That seems much more likely to happen. Any evidence about that? -
Michael Malloy
Somehow this seems terribly unhelpful -
Jose Ramos
Although there are still many gaps in relation to the best equipment, recent evidence has demonstrated the importance of the role of the T-piece resuscitator, especially in terms of reducing lung injury. In this sense, it seems to me important that the neonatal resuscitation program encourages universal training -
Pramod Mallipaddi
T-piece is theoretically superior. In practice, when you have less support(which happens more often than we expected in non-academic settings) in the delivery room, using a T-piece can be cumbersome to use. To get a good chest rise, you may need to change the T-piece dial a few times, requiring assistance from a well-versed person. People lose time struggling to change the pressures on a T-piece. At least, in the first few breaths, when we determine the PIP required to see a good chest rise, a self-inflating bag may be superior as we can change the PIP with each breath until the team achieves desired PIP. -
Ibrahim Sammour
PEEP expiratory valves are dependent on tidal volume being delivered and exhaled when used with self-inflating bags. Since no flow occurs through the inspiratory valve without the bag being compressed PEEP exhalation valves are likely unreliable in providing PEEP with very low tidal volumes. With flow-inflating bags, the valve controls flow and PEEP together given that the exhalation valve is a fixed orifice. This ties the rate of bag insufflation with PEEP being administered. With higher rates of PPV (remember the rate is 40-60 in NRP) this can lead to inadequate insufflation of the bag. Furthermore, depending on how the flow is set up and adjusted during PPV, PEEP is often only established towards the beginning of the next breath rather than end inspiration; i.e there is a dip in circuit pressure close to 0 cm H2O which could potentially hamper recruitment of FRC efforts. -
José Ramos
Although the evidence of late clamping of the umbilical cord of vigorous newborns over 34 weeks is still weak, this attitude seems more sensible and more consistent with the nature of the act of birth. We have some evidence of decreased anemia and for less developed countries it can have a long-term impact. -
Michael Tyler
Your quotation of the Wright EH paper is incorrect (human model of burn injury...) as it leaves my name out (Tyler MPH) otherwise great review- thanks -
Guillaume Debaty
As one of the researchers involved with the discovery of head-up CPR, I am writing to request that the ILCOR substantially modify its recommendation on the subject. As pointed out, most of the evidence available to date is experimental. The positive effects in preclinical settings were only observed with the use of a bundle of care including active compression decompression CPR (ACD), the use of an ITD and progressive elevation of the head and torso (HUP) [1-6]. I’m feeling that the current writing of your consensus on science and justification doesn’t reflect the need to use this bundle of care. For human clinical evidence, we are currently running the first pilot clinical study to assess the fully integrated system of ACD+ITD HUP CPR : NCT03996616. Taking in consideration the lack of clinical evidence to date on the bundle of care, with only one clinical study by Pepe et al [7] assessing multiple different interventions including an elevation of the stretcher head, I think any conclusion on clinical use of head-up CPR would be premature. The Pepe study, while offering interesting preliminary data, is very different than the bundle assessed in animal studies. Based on these comments, in my opinion with the current data available, it would be better to make no recommendation on the subject because the available evidence would make any estimate of effect speculative. [1] Moore JC, Salverda B, Rojas-Salvador C, Lick M, Debaty G, Lurie K. Controlled sequential elevation of the head and thorax combined with active compression decompression cardiopulmonary resuscitation and an impedance threshold device improves neurological survival in a porcine model of cardiac arrest. Resuscitation. 2021;158:220-7. [2] Rojas-Salvador C, Moore JC, Salverda B, Lick M, Debaty G, Lurie KG. Effect of controlled sequential elevation timing of the head and thorax during cardiopulmonary resuscitation on cerebral perfusion pressures in a porcine model of cardiac arrest. Resuscitation. 2020;149:162-9. [3] Moore JC, Salverda B, Lick M, Rojas-Salvador C, Segal N, Debaty G, et al. Controlled progressive elevation rather than an optimal angle maximizes cerebral perfusion pressure during head up CPR in a swine model of cardiac arrest. Resuscitation. 2020;150:23-8. [4] Moore JC, Segal N, Debaty G, Lurie KG. The "do's and don'ts" of head up CPR: Lessons learned from the animal laboratory. Resuscitation. 2018;129:e6-e7. [5] Moore JC, Holley J, Segal N, Lick MC, Labarere J, Frascone RJ, et al. Consistent head up cardiopulmonary resuscitation haemodynamics are observed across porcine and human cadaver translational models. Resuscitation. 2018;132:133-9. [6] Moore JC, Segal N, Lick MC, Dodd KW, Salverda BJ, Hinke MB, et al. Head and thorax elevation during active compression decompression cardiopulmonary resuscitation with an impedance threshold device improves cerebral perfusion in a swine model of prolonged cardiac arrest. Resuscitation. 2017;121:195-200. [7] Pepe PE, Scheppke KA, Antevy PM, Crowe RP, Millstone D, Coyle C, et al. Confirming the Clinical Safety and Feasibility of a Bundled Methodology to Improve Cardiopulmonary Resuscitation Involving a Head-Up/Torso-Up Chest Compression Technique. Crit Care Med. 2019;47:449-55.