Recent discussions
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marije hogeveen
I would like to thank the authors for their work. This provides us with an excellent overview on the latest evidence on the use of video laryngoscopy. Based on this evidence, I support the recommendations, especially because the main recommendations is stated as conditional on training and resources
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marije hogeveen
is there an EtD table available for easier reading?
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Nicole Udse Luis
Acredito que a recomendação de uso de videolaringoscopio seria benéfico para o procedimento em recem-nascidos prematuros. Não estaria disponível de imediato em todas as unidades mas uma recomendação nesse sentido indicaria a importância do material. Acredito que traria menor risco ao procedimento com intubacoes mais rápidas e menos tentativas.
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Celso Rebello
The use of video laryngoscopy with appropriate equipment for extremely premature infants (0-0 blade) is a step forward both in the practice and in the teaching of procedures that require laryngoscopy. This includes not only intubation (which is the subject of this public consultation) but also the administration of surfactant through a thin catheter. I agree with the proposed recommendation.
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Paulo Fernando Martins Filho
I do not face any difficulty in performing neonatal intubation using the traditional method. But I understand that this tool could help us optimize the technique and improve our intubation outcomes. However, the necessary equipment is expensive and scarcely available in maternity wards in Brazil.
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Ana Isabel Coelho Montero
Muito interessada em saber do resultado
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Chris Lindsell
As a person who, in their profession attends many arrests. I see the use of mechanical devices particularly the Lucus as very problematic due to poor placement and time off the chest. There needs to be more emphasis that these should not be used routinely when not necessary. I also see trauma to the skin often and am aware of the the psychological impact from family members, especially with the Lucus when hands are attached to the machine.
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Mohamud Daya
Without high-quality data supporting AL vs AP pad placement in cardiac arrest, both should be allowed as options, as they are in the current ERC guidelines, without recommending AL as a preferred approach. Many factors influence impedance, including pad size, pad position, intervening tissue (an issue with obese patients), timing (lungs expanded vs not), pressure on the pads, etc. AL pads may also be easier to misplace than AP, though we need more data to understand this.
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Kerry Bachista
Third, I encourage your group to consider the potentially stifling effect statements like this can have on innovation. Every incremental improvement in survival rates translates into lives saved. The national survival rate for cardiac arrest has stagnated for decades, making it essential to explore new paradigms. Dr. Peter Safar, the father of CPR and rescue breathing and a three-time Nobel Prize nominee, warned of the limitations of randomized controlled trials (RCTs) in resuscitation research prior to implementation. In his autobiography Careers in Anesthesia (2000, Wood Library-Museum of Anesthesiology), he discusses how “The enormous number of unknown or uncontrollable clinical variables makes it impossible to control RCTs and to prove no effect.” He emphasized that: “Convincing positive results from outcome studies in reproducible large-animal outcome models should replace clinical randomized outcome studies in CPCR research, while clinical feasibility and side-effect studies should precede any treatment becoming part of guidelines for routine use. “
The current consensus statement: “We suggest against the use of head-up CPR or head-up CPR bundle during CPR except in the setting of clinical trials or research initiatives (weak recommendation, very-low-certainty evidence)"—is too cautious. This approach is why we have had stagnation in survival rates over the past 50 years. Although I don’t claim that the head-up CPR bundle is the ultimate solution or that there aren’t other advancements on the horizon, the outcomes we've seen in my EMS system have been better than those we’ve achieved with standard CPR. While there is demand by some for a large RCT. Who will do that and spend the money with position statements angling on discouraging? All innovation has costs at first, but then becomes more available at scale. If we poison the well of development, then we will continue to stifle our work and humanity pays the price.
Therefore, I encourage you to revise your recommendation to something more constructive, such as: "Head-Up CPR, when implemented with a head and thorax patient positioning system device, suction cup-based active compression-decompression CPR, and an impedance threshold device, could be considered a complementary option for cardiac arrest patients, with low certainty of evidence. This approach is supported by animal studies and observational human studies and warrants further investigation."
Thank you for again for allowing. comments.
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Elibene Junqueira
I agree with Ilcor's guidance