Consensus on Science with Treatment Recommendations (CoSTR)
I teach BLS to first aiders + Dr Surgery staff. Most need prompting to give 2 effective breaths, within Zoll's rexommendation of not stopping CPR for longer thaan 5 seconds.
Some need prompting to re-open airway.
So 50:2, sounds great.
But, all PAD's would need recalibration.
**When performing CPR for an OHCA by a lay responder, I recommend the promotion of continuous compression CPR with the option of ventilation every 10-15 seconds when a second person arrives to assist and a ventilation barrier device is available.
**I recommended we maintain the 30:2 compression to ventilation ratio for health care providers.
My experience is we that traditionally we develop our protocols and science based on the outcome of the patient, and not necessarily inclusive to the human factors of the provider or lay-responder. In a sample of 66 OHCA, I followed up directly with the lay-responders. The training varied from “what I seen on TV” to a health care provider. In this sample 35 performed continuous compression CPR, 28 identified as performing 30:2, and 2 cases of 15:2. One case the lay responder couldn’t recall. When reviewing event data from AED’s, CCTV, and responders self-admitting only 11 cases had regular intervals of compression to ventilations. Feedback that we collected from the responders indicated that the acute stress in the moment effected their ability to count, keep track, and perform regular compression to ventilation intervals, as well as the lack of barrier devices. They also identified that agonal breathing, seizure like movements, vomiting, and other factors played a part in the inconsistencies of performing proper 30:2 CPR, starting, stopping, waiting. The messaging of continuous compression CPR was prevalent, and most performed that method. Some with sporadic ventilations provided. The health care professionals were more adept to performing 30:2 with regular intervals, over true lay-responders/first aiders, or those who have taken training 5+ years prior. I recommend we teach continuous compression CPR and if a second person is able to help and has barrier device they can administer 1 breath every 10-15 seconds simultaneously. Switching roles when the person providing compressions becomes tired. The message needs to be simple, factor in human factors, and the realities of a cardiac arrest from the lay-responder and first aider’s perspective. I would be happy to share more on this issue. Short of writing a paper in the comments section of the discussion.
Your recommendations are that a despatcher not interfere with CPR already in progress. And intervene when no action is being taken. They are prudent. Bystanders familiar with CPR will initiate CPR. There is recognition that conventional CPR is superior to chest compression only CPR in Pediatrics irrespective of cardiac or non-cardiac etiology. So, greater emphasis should be given to interested layperson’s access to structured Pediatric BLS courses including airway issues pertinent to choking & recognition of cardiac arrrest.
This is an excellent review that really encapsulates the available evidence in premature infants. I especially appreciate the clear discussion of the findings and the explicit recognition of the meaning of "neither harm nor benefit". The authors then make clear the basis for their recommendations, and finish by explicitly recognizing the limitations in the evidence base. Thank you.
Would like to reiterate the same fact that in a resource constraint setting, a guideline should be feasible to use. After having attended many preterm deliveries and also as a national NRP faculty my opinion is skewed towards using room air for resuscitation of a preemie as well. Targeted Pre ductal sat may not be feasible in many of the delivery room settings and most of the settings don't have a blender to deliver required FiO2. In those cases, chances of harm is a real possibility with using 100% oxygen in preemies. There needs to be a clear cut guideline for these scenarios. Room air ventilation works well with either an AMBU bag or a T piece RESUSCITATOR (if available).
Having attended thousands of deliveriesband being a national NRP instructor, I'm of the opinion that room air is physiological and works absolutely fine. Single most important event is ventilating the lungs and in resource poor settings, where the burden of neonatal resuscitation is really huge, it makes sense to come up with a feasible guideline. Room air should be made the norm without any ambiguity.
I agree. We are following the recommendations with great results in the delivery room. We have serious problems in the transport, because we have great difficulties in providing compressed air for use in the transport.
"My humble request to you all: Report from 195 countries suggest children are suffering from hypoxia during birth and suffering from brain damages and exponential rise of Autism PLEASE SAVE THE CHILDREN IN THIS WORLD NOW AND MAKE A BETTER WORLD FOR TOMORROW . NEWBORN BLUE BABIES HAVE BEEN SUFFERING FROM HYPOXIA ( LOW OXYGEN ) INJURIES TO THEIR BRAIN, BEGAN IN 2006 AND MUST END NOW. THE TIME HAS COME TO CHANGE THE NRP/ILCOR/ANZCOR/ EUROPEAN NEWBORN RESUSCITATION COMMITTEES GUIDELINES IMMEDIATELY # REPORT FROM 195 COUNTRIES ( FROM 1990 TO 2015 ) ; GLOBAL BURDEN OF DISEASES ( GBD ) AND DEATHS FROM PRETERM BIRTH COMPLICATIONS, LOWER RESPIRATORY INFECTIONS, BIRTH ASPHYXIA, TRAUMA, CANCERS AND EXPONENTIAL RISE OF AUTISM. 90% newborn babies are pink within 1 minute. Why remaining 10% will suffer ? We are supposed to help them in the delivery room.
Premature babies brain are more vulnerable than that of full term.
We should all together help these children by all means and end their suffering.
THIS IS UTMOST REQUEST TO YOU ALL.
Parents are stressed out, they are not aware, no consent is obtained that their blue babies will remain blue over 10 minutes after birth.
PLEASE HELP THEM.
# Care for Autism and Other Disabilities — A Future in Jeopardy ( USA ) http://jamanetwork.com/journals/jamapediatrics/fullarticle/2613463?utm_medium=alert&utm_source=JAMA%20PediatrPublishAheadofPrint&utm_campaign=03-04-2017 http://jamanetwork.com/journals/jamapediatrics/fullarticle/2613461?utm_medium=alert&utm_source=JAMA%20PediatrPublishAheadofPrint&utm_campaign=03-04-2017 http://www.nejm.org/doi/full/10.1056/NEJMp1700697?query=pediatrics"
I agree. The majority of late premature and term infants with indication of ventilation
with positive pressure, improve with increasing residual capacity without the use of oxygen in high concentrations.