Recent discussions
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Виктория Антонова
Agree. UVC is the preferred route but if it can't be placed (i.e. week old infant) and peripheral access is not easily obtained an IO is the only other option. -
Виктория Антонова
Acho o cateterismo umbilical mais seguro para acesso vascular no momento da reanimação neonatal O acesso IO requer prática e principalmente material próprio para evitar complicações óssea no RN -
Виктория Антонова
As mentioned by Scott DeBoer in an earlier comment, there are few if any EMS agencies in the U.S. that perform UVC. The recommendation language should be worded differently for pre-hospital vs. in-hospital personnel. This recommendation will be disregarded by most of us in EMS based on the current wording mainly due to impracticality. Furthermore, we have moved to the distal femur for IO placement in pediatric arrest with good success. We do agree that the proximal tibia IO site is fraught with difficulties and complications. -
Виктория Антонова
Thank you for this review. We welcome the positive acknowledgement of efficiency that stroke recognition tools can have for the lay public and positive outcomes. The discussion in your justification narrative rightly defers to those providing local guidelines for responders regarding the use of glucose which, from an educational perspective is perhaps better suited to the trained first responder. Perhaps an additional gap in existing knowledge is the ability of a lay responder to make the decision to take the test, their ability to do so, and the pathway for decision-making beyond the test. -
Виктория Антонова
I totally agree with Scott (not surprising) but in the prehospital/ED world IO is often a much more available/usable option and given the lack of any good evidence should not be treated as a "bad" choice -
Виктория Антонова
I agree with the treatment recommendations. -
Виктория Антонова
Várias perspectivas devem ser consideradas. A mais importante, é nos investirmos totalmente, na RCP de alta performance , na tentativa real e humana de salvarmos o RN. Pois bem, o acesso I.O. PODE ser mais rapidamente obtido, em relação ao cateterismo umbilical ; já que durante as compressões torácicas coordenadas com ventilações, a visualização direta da veia umbilical, possa ser dificultada ,ou por extravasamento sanguíneo contínuo, ou mesmo por hipovolemia severa, que imporia uma condição de colabamento da veia umbilical. Quanto à velocidade de infusão de drogas e cristalóides, é possível uma distinção entre as duas vias de acesso vascular. Por serem técnicas distintas, merecem discernimento e ponderação, a respeito dos possíveis insucessos inerentes a tais procedimentos, sem contudo abrirmos mão dos benefícios de um acesso venoso de instalação rápida no ambiente da Reanimação Neonatal. -
Виктория Антонова
Utilizo acesso umbilical para os procedimentos de reanimação na sala de parto. Mas seria interessante avaliar a possibilidade de uso da via intra-ossea nos recem-nascidos. -
Виктория Антонова
Re: GWR - not clinically helpful to sub-divide in to so many different regions for purposes of this review and may be more helpful to group the analysis as simply saying multiple ROIs were evaluated. Also unclear why this SR divided cardiac and non-cardiac etiologies when others did not (even when it was reported for the individual studies). Continue to have concerns about how ILCOR is making TRs based on parameters that lack a standard definition and are basically a hodge-podge of different things lumped together in a SR (ie for the DWI section, cannot make generalizations about "positive DWI findings" - this could be a small clinically insignificant DWI lesion vs diffuse cortical necrosis, and the current recommendation does not differentiate) References missing some of the articles - Greer, others. Perhaps just not listed on this cover page? Re: DWI and ADC work - consider the following studies from our group as well (not sure if they fit the inclusion criteria for the SR but if they do they are relevant) - Hirsch et al, J Neuroimaging - Prognostic value of a qualitative brain MRI scoring system after cardiac arrest, 2015. Hirsch et al, Neurocritical Care - Multi-Center Study of Diffusion-Weighted Imaging in Coma After Cardiac Arrest, 2016. -
Виктория Антонова
Agree that more research is needed but in the meantime and with the evidence (or lack of) available I think the authors recommendations are quite balanced and appropriate. For DR resuscitation where people are skilled/experienced with UVC placement I don't see the role for IO. However, in other settings (ie. ER, community hospitals) where practitioners have limited training/experience with UVCs, IO is a reasonable alternative (better than peripheral IV in my opinion). Thanks