Recent discussions
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Dominic Larose
The study was done with a rectilinear biphasic defibrillator at 200J. Most likely the conclusion would be the same with a biphasic truncated exponential defibrillator at 360J, but of course this can't be known for sure unless this would be tested. -
Jamie Tegart
We currently perform the recommended 3:1 compression:ventilation as per NRP guidelines. I would be curious what exactly is meant by the cardiac compressions with sustained inflation (SI). Two studies have commented on the positive results of using SI and I think more clinical studies could be warranted. -
Jamie Tegart
Our site currently only teaches the two thumb techinique with emphasis on starting at the head of the bed. This is to help reduce the need to pause while setting up for UV insertion, as well as reduce fatigue and uneven pressure from compressing at the side of the bed. I would be interested about some of the methods mentioned which potentially provide improved compression rate and depth along with decreased fatigue. -
Jamie Tegart
I think that a HR of under 60 is still an acceptable rate to use, for now, as that is what is currently practiced at most sites. While there is enough evidence to agree that a rising chest & audible air entry are acceptable indicators of effective ventilation, along with a rising HR as the primary indicator. I would be curious to review length of time providing effective ventilation before starting chest compressions. Our current practice is 30 seconds. Since we know that most infants are in a respiratory arrest and not a cardiac maybe more emphasis on the length of time effective ventilation is being done for would be beneficial -
Elene Vanderpas
As previous evidence has shown that the 2-thumb technique is superior to the 2-finger technique, why does the American Heart Association's instructional video for parents/caregivers, "Infant CPR Anytime", teaches the 2-finger technique? -
Jamie Tegart
Regardless of gestation or response to initial steps all our initial HR (heart rates) are achieved by auscultation. We do place ECG & SpO2 devices on infants who remain non vigorous after initial stimulation. ECG is definitely quicker and more accurate than pulse oxymetry for results, especially in those with a lower HR. -
Silvia Heloisa Moscatel Loffredo
Matter of great importance. Newborns, especially when born prematurely and submitted to advanced resuscitation, reaching the stage of chest compressions, require actions that minimize the deleterious effects of hypoxemia, as well as diffuse multisystemic injuries caused by hyperoxia.Thus, healthcare institutions must recognize the need to monitor oxygen saturation, the use of pulse oximetry, allowing further studies to clarify how supplementation of supplementary oxygen should be indicated. -
Silvia Heloisa Moscatel Loffredo
Considering the expressive percentage of neonatal deaths due to asphyxia and that the systematic review showed that heart rate assessment can be obtained more quickly and accurately using the Electrocardiogram (ECG) during newborn resuscitation in the delivery room when compared to other evaluation methods, I believe that these studies will be able to instrumentalize the limited resources institution's managers, showing them that obtaining the ECG equipment to qualify asphyxiated newborn assistance may impact the reduction of expenses with treatment of complications of the asphyxia process. -
Silvia Heloisa Moscatel Loffredo
Being a decisive moment in the resuscitation of the newborn in the delivery room, the explanation of the concerns that refer to the technique during neonatal chest compressions mentioned in this CoSTR must be performed. The continuation of further studies are extremely important for this reason. -
Jamie Tegart
Our hospital currently has access to stethoscope, pulse oximeter & ECG. For most codes, initial HR is still obtained by stethoscope as it does not require infant to be moved from Mom unless necessary. ECG monitors are brought to codes or pre-set when time allows. The use of pulse oximetry is more common if the infant is not responding to initial steps, however it is not generally accurate if the HR remains low and shouldn't be solely relied on. While more costly, increasing access to ECG monitors could allow for improved outcomes during resuscitations.