Recent discussions
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Виктория Антонова
The term "epileptiform" should not used any more to describe discharges, because it is unclear whether the discharges are actually epileptiform and the term epileptiform has clinical connotations. There are some discharges that are more benign and would not be considered epileptiform. This is outlined in a previous ACNS statement that is cited in the ETD table (Hirsch 2013 J Clin Neurophys) and the correct terminology should be used. It perpetuates the problems with this research (ie lack of standard definitions) when we use outdated terminology. Suggest removing the term "epileptiform" and simply saying "discharges" in order to be consistent with critical care EEG definitions. -
Виктория Антонова
Lifevac has provided 44 clinical files of effective use , no adverse effects in the exact format requested by ILCOR . As we are all aware in field emergency with approx 8 min to implement this is a substantial accumulation . As it has been used by laypeople as well as professionals , on people from 7 weeks to 90 plus years of age what else would be needed. Thank you -
Виктория Антонова
Might want to consider amending to "We suggest against using routine point-of-care transthoracic echocardiography for prognostication during cardiopulmonary resuscitation of undifferentiated cause (weak recommendation, very low certainty of evidence). Most referenced studies involve undifferentiated arrests; however, patients with a high index of suspicion of reversible cause have not been sufficiently investigated to provide much evidence for a recommendation. In addition, transesophageal echo has not been evaluated sufficiently to include at this time, although it will likely be subject to similar caveats. -
Виктория Антонова
We are currently evaluating efficiency, success rates and confidence with drill-assisted versus manual IO placement in a size-appropriate newborn ovine asphyxial arrest model. Our preliminary data suggest more efficient placement, higher success rates and greater confidence with drill-assisted IO, supporting the use of a drill when this procedure is needed. In addition, we are evaluating pharmacokinetics and efficacy of IO as compared to UV epinephrine, with preliminary data suggesting comparable efficacy but differences in epinephrine peak and hemodynamics. These studies are supported by funding by the Neonatal Resuscitation Program and have been submitted for presentation at the Pediatric Academic Society Meetings. -
Виктория Антонова
It already says: "We suggest umbilical venous catheterization as the preferred vascular access during newborn resuscitation" -
Виктория Антонова
In my opinion, umbilical cord venous access should be first line. IO access in neonates is associated with high rates of incorrect placement. -
Виктория Антонова
We irregularly (3-5 per annum) see IOs placed during neonatal resuscitation. This is especially done by hospitals that do not have a dedicated neonatal service. For non-neonatologists i.o. seems to be an attractive alternative, especially if they have not had adequate training in umbilical catherization or are from a background in emergency medicine. The io definitely needs to be better evaluated for efficacy and success rates. We have seen a few case were more than 1 attempt was needed for successful placement. Placement in preterm infants seems even more challenging. I believe it should remain in consideration when the UVC is not deemed a reasonable alternative. -
Виктория Антонова
Since obtaining umbilical venous access is fast, safe and painless, it should always be the first method to obtain vascular access in a newborn. Peripheral intravenous access should also be part of this recommendation. The recommendation should be revised as suggested below: For Treatment Recommendations The treatment recommendations should be modified as follows: (quotation marks and capitals are used to indicate the changes): For the First statement: Umbilical venous catheterization IS the preferred vascular access "AND SHOULD BE ATTEMPTED FIRST TO OBTAIN VACULAR ACCESS" during newborn resuscitation. This should also be a Strong Recommendation. It may need different methodological science than used for other recommendations based on the unique vascular structures and physiology present in utero and at birth. I would liken it to the science used in recommending in a neonatal emergency translaryngeal intubation vs. a tracheostomy. And for the second statement: (Remove: "If umbilical venous access is not feasible".) AFTER FIRST ATTEMPTING TO OBTAIN VASCULAR ACCESS VIA THE UMBILICAL VEIN, PLACING A PERIPHERIAL INTRAVENOUS CATHETHER WOULD BE THE SECOND PREFERRED METHOD FOLLOWED BY the intraosseous route as vascular access during newborn resuscitation AS reasonable alternatives. -
Виктория Антонова
Thank you for all the comments and input so far. Please keep them coming. The task force will assess all comments and derive themes or information to use to adjust the CoSTR where appropriate. Thank you everyone for engaging with this process. Vice Chair NLS Task Force -
Виктория Антонова
As a provider who has placed 5 IO's in code situations in the last few years and more emergent UVCs in the delivery room than I can count, I agree that the UVC should be the preferred access. The infants receiving IO's weights ranged from 2 to 4 kg and they all extravasated at some point in the resuscitation. Perhaps it was my technique but I would prefer a UVC whenever possible given the higher complication rate in my limited experience. That being said, if the IO was my only option, it seems reasonable.