Recent discussions
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Mohammad Abdul MANNAN
Just after birth when there is minimum or no aeration in the lungs probably chest compression : ventilation ratio 3 : 1 is quite satisfactory but anytime later during neonatal period may be chest compression : ventilation ratio 15 : 2 or any new rate as lung fields are different now and small volume of cardiac output. -
Colin Morley
The review mentions potential concerns with the use of exhaled CO2 to guide IPPV by facemask at birth. It is possible that dead-space ventilation of the mask, oropharynx, and trachea causes insufficient renewal of the expired volume. Although dead space ventilation might be a problem it is unlikely because there is commonly a leak around the face mask or ETT and so there is a continuous flushing of gas in the mask. -
Mohammad Abdul MANNAN
The difficult breathing of a term newborn interferes oxygenation, metabolism and heart rate so supplemental oxygen, instead of room air should be provided to a term newborn during resuscitation/CPR/chest compression. Controlled oxygenation (30%) for preterm and 100% oxygenation for chest compression will remain the same with intubation. -
Colin Morley
Most neonates have a healthy heart and the bradycardia mainly occurs because the myocardium is hypoxic. The best way to improve bradycardia just after birth is good lung fluid clearance, formation and maintenance of an FRC and thereby aeration to oxygenate the blood. This review assumes the cardiac compression is being started, "after successful inflation of the lungs." Unfortunately, there is no way resuscitators can determine successful aeration of the lungs. If there is bradycardia the first thing to do is improve ventilation by increasing the peak inflation pressure, or tidal volume if measured, maintaining the inflation for at least 1 second, and ensuring adequate PEEP to maintain lung volume. This review is about chest compression but before that is done either this, or another PICOST should does mention techniques of ensuring adequate lung aeration before chest compression. -
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. -
John Mouw
On a practical note, the resources both in cost to increase defibrillator availability and competency training to perform DSED would be higher than with VC. For this reason and others, a DSED to VC comparison study is needed. Until a single DSED defibrillator is manufactured a meaningful DSED to VC comparison will prove challenging. -
Lorena Monte
The use of plastic bag, the use of room temperatures of ≥23°C, the use of a head covering has been suficientes for maintain an adequate baby temperature. The unavailability of the thermal mattress is not being a problem in the daily pratice. I wonder if infants longer than 34 weeks would also benefit from these measures, when they cannot have skin-to-skin contact -
Jane Robert
My stepdad was diagnosed with MND ALS in the summer of 2013; His initial symptoms were quite noticeable. He first experienced weakness in his right arm and his speech and swallowing abilities were profoundly affected. We all did our best to seek help for this disease no medications they prescribe worked, we were all scared we might lose him due to his condition, as he had been his brother's caregiver a few years earlier for the same disease before he passed. The doctor recommends natural treatment from Multivitamin herbal cure for his ALS we have no choice but to give a try on natural organic treatment, this herbal cure has effectively reversed my father's condition, losing his balance which led to stumbling and falling stopped after completing the herbal supplement which includes his weakness in his right arm and his speech. Home remedies from www. multivitamincare. org is the best although their service is a little bit expensive it is worth it, they save lives. -
Dominic Larose
I agree that before considering VC or DSD, proper position of the defibrillation electrodes should be optimal. Many physicians do not position the left electrode in the optimal, mid axillary position. Most place it too anteriorly. (Heames RM, Sado D, Deakin CD. Do doctors position defibrillation paddles correctly? Observational study. BMJ. 2001 Jun 9;322(7299):1393-4. doi: 10.1136/bmj.322.7299.1393. PMID: 11397743; PMCID: PMC32253.). In a study of manufacturers illustration of paddle position, it was found that none of them showed the ideal one. (Foster AG, Deakin CD. Accuracy of instructional diagrams for automated external defibrillator pad positioning. Resuscitation. 2019 Jun;139:282-288. doi: 10.1016/j.resuscitation.2019.04.034. Epub 2019 May 5. PMID: 31063839.) Training manikins also shows a sub-optimal position (https://laerdal.com/ca/information/cpr-manikins/). AHA videos, such as this one at 7:08 min shows an incorrect position https://www.youtube.com/watch?v=uD4ByZFULIg. I suggest to change the wording of anterolateral position (even worse: antero-apical) to antero-axillary. That one of the most important therapy for VF cardiac arrest is not done or teached in an optimal fashion should be a cause of great concern for the ILCOR comitee. There should be great emphasis to better teach proper position of the defibrillating pads in future training materials. -
Jamie Tegart
We currently use a colorometric for intubation. There has been discussion, at our site, about the use of CO2 detectors during IPPV, however it has not been a common practice. I do see the potential benefit from it as another indicator that PPV is successful, and would be interested in seeing if more sites adopt this into practice