Consensus on Science with Treatment Recommendations (CoSTR)
Great discussion of a very important point. Agree that for those in the Delivery Room with experience and equipment, the UVC is a simple , fast and reliable method. As long as it is only placed in 2 to 4 cm, there is no need for radio-graphic confirmation during an emergency. Agree completely with Scott De Boer regarding situations outside of the DR.- ie the responder/provider in the ED, in the field, in facilities without experience in UVC placement, or where you did not get the emergent UVC, or the neonate with a dried cord. The skill to place a IO can be life saving. This skill has to be practiced. The task training to place an IO is a critical skill for those responding to emergencies. If one does not have a "drill" or a "manual" IO devise a larger spinal needle could be used- 13, 18. (or 20 gauge) .The problem is the length of those needles. My opinion is that it is a skill that should be included in neonatal resuscitation training-especially for non NICU/DR providers.
I am conducting an intervention study related to neonatal resuscitation in one of the poorest regions of Brazil. In this region, there are no doctors specializing in neonatology, the structure is very precarious and about 7000 newborns are born per year. I believe that IO training for this population would be more feasible given the difficulty of a practitioner with poor CUV practice succeeding in advanced resuscitation.
In the prehospital ED adult cardiac arrest the IO is faster with better flow than a peripheral IV (if humeral) and is not "traumatic" as someone above said. I would hate to see people pushing IV with often significant delays with multiple attempts at a peripheral IV.
I totally agree with Scott (not surprising) but in the prehospital/ED world IO is often a much more available/usable option and given the lack of any good evidence should not be treated as a "bad" choice
Thank you for this review. We welcome the positive acknowledgement of efficiency that stroke recognition tools can have for the lay public and positive outcomes. The discussion in your justification narrative rightly defers to those providing local guidelines for responders regarding the use of glucose which, from an educational perspective is perhaps better suited to the trained first responder. Perhaps an additional gap in existing knowledge is the ability of a lay responder to make the decision to take the test, their ability to do so, and the pathway for decision-making beyond the test.
As mentioned by Scott DeBoer in an earlier comment, there are few if any EMS agencies in the U.S. that perform UVC. The recommendation language should be worded differently for pre-hospital vs. in-hospital personnel. This recommendation will be disregarded by most of us in EMS based on the current wording mainly due to impracticality. Furthermore, we have moved to the distal femur for IO placement in pediatric arrest with good success. We do agree that the proximal tibia IO site is fraught with difficulties and complications.
Várias perspectivas devem ser consideradas. A mais importante, é nos investirmos totalmente, na RCP de alta performance , na tentativa real e humana de salvarmos o RN. Pois bem, o acesso I.O. PODE ser mais rapidamente obtido, em relação ao cateterismo umbilical ; já que durante as compressões torácicas coordenadas com ventilações, a visualização direta da veia umbilical, possa ser dificultada ,ou por extravasamento sanguíneo contínuo, ou mesmo por hipovolemia severa, que imporia uma condição de colabamento da veia umbilical. Quanto à velocidade de infusão de drogas e cristalóides, é possível uma distinção entre as duas vias de acesso vascular. Por serem técnicas distintas, merecem discernimento e ponderação, a respeito dos possíveis insucessos inerentes a tais procedimentos, sem contudo abrirmos mão dos benefícios de um acesso venoso de instalação rápida no ambiente da Reanimação Neonatal.