Recent discussions
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Louise Owen
I understand that the evidence directs us to potentially different treatments in different groups of newborns, that may be confusing for clinicians. How this is worded will be critical. To state that 60s of DCC is recommended for ALL preterm infants is clear, and then add a caveat to say that when this is not possible to consider UCM only for those >28w might reduce the number of msgs.
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Renata de Araujo Monteiro Yoshida
I agree that we should try to offer the best treatment for each gestational age, but I worry about the formation of a group as large and heterogeneous as the 28-36 week group.
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Виктория Антонова
I appreciate the intentionality of the researchers involved to address this glaring question that has largely been unaddressed. The research questions they seek answers to as well as the willingness to update their search four times in the process of analyzing while preparing the recommendations highlights there awareness of the newness and potential implications of these research questions. Based on the data provided, it appears that each of the recommendations is consistent with and directly tied to the outcomes as demonstrated. Thank you for your effort. -
Karina Andrade
I totally agree, too
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Roger Brock
I totally agree
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Federico Zaglia
I would support the implementation aiming for a routine use of at least posters.
We are currently doing so, to ensure adhesion to GGLL beyond the personal knowledge trained in simulation sessions.
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Julena Ardern
While I like the incision of DCC during resuscitation I can help but feel multiple different recommendations for different age groups is going to be confusing. As an NSL instructor the beauty of teaching the current algorithm is reinforcement through repetition. By introducing different methods of placental blood transfer for different gestations I believe that this will lead to mistakes, which can have adverse effects at the lower gestations. At present (in New Zealand) we teach infants <30 weeks being resuscitated in 30% FiO2, with lower pressures and use a thermal wrap. While some of the current evidence and associated recommendations are aimed at 28 weeks, it may be beneficial for pattern recognition to include this in the <30 week bundle of care.
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Zachary Davies
I believe that yes - OHCA patients should be taken to a cardiac arrest centre but only if one of the following criteria are met
- ROSC (if considering bypass then must be stable or be able to be managed until arrival at the centre)
- Higher likelihood of a good neurological outcome (i.e. a low MIRACLE2 score)
- Intra-arrest transport only if there is an obvious or highly likely cause of arrest that cannot be managed prehospital
- It is the closest receiving hospital
Similarly to regional trauma networks, there should be stringent bypass criteria, perhaps requiring oversight of a senior or specialist clinician.
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Robert Major
Patients presenting in a shockable rhythm OHCA,, who subsequently achieve ROSC, should be cared for in a cardiac centre. We have presented (EUSEM conference) retrospective observational data (for 2407 OHCA patients) showing Utstein patients have significantly lower mortality if taken direct to a cardiac centre post ROSC. We are publishing this work.
In geographical areas with longer journey times or less specialist centres going first to a cardiac centre will have survival benefits, In comparison to highly urban areas where transfers occur more easily and quickly to specialist hospitals. -
Federico Semeraro
Dear all,
I apologize for the multiple comments. I wasn’t recognized as the author in my first two comments.
Here are some additional references for your evaluation, specifically for the second part of the TR:
Alcázar Artero PM, Greif R, Cerón Madrigal JJ, Escribano D, Pérez Rubio MT, Alcázar Artero ME, López Guardiola P, Mendoza López M, Melendreras Ruiz R, Pardo Ríos M. Teaching cardiopulmonary resuscitation using virtual reality: A randomized study. Australas Emerg Care. 2023 Sep 2:S2588-994X(23)00055-6. doi: 10.1016/j.auec.2023.08.002. Epub ahead of print. PMID: 37666723.
Alcázar Artero PM, Pardo Rios M, Greif R, Ocampo Cervantes AB, Gijón-Nogueron G, Barcala-Furelos R, Aranda-García S, Ramos Petersen L. Efficiency of virtual reality for cardiopulmonary resuscitation training of adult laypersons: A systematic review. Medicine (Baltimore). 2023 Jan 27;102(4):e32736. doi: 10.1097/MD.0000000000032736. PMID: 36705392; PMCID: PMC9875948.
Best wishes
Federico Semeraro