Recent discussions
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Виктория Антонова
Who would consider dropping UVC harder than I/O at birth ? It's likely the easiest procedure and in almost all cases fail proof, if attempted in delivery room -
Виктория Антонова
So many people chiming in and saying UVC first when in fact the article itself says "We suggest umbilical venous catheterization as the preferred vascular access during newborn resuscitation". Read first people! -
Виктория Антонова
Hi there - thank you for the robust review I feel that other factors should be considered when considering the publication of this position statement - definition for cardiac activity - most user friendly definition comes from the Gaspari paper - any 'visible motion of the myocardium excluding valvular or blood motion'. This is readily interpreted by many medium level users - by discouraging the use of POCUS at an arrest, you may miss the early diagnosis of reversible causes eg tamponade - using POCUS as part of the clinical support decision tree to cease resuscitation is better than the absence of clear clinical indicators that are currently in use I agree with your statement re caution about linking RV dilation to a diagnosis of PE I disagree with your statement about POCUS causing a prolongation in duration of chest compressions in the Huis study. This was a small study completed at a single centre. It should not be used to generalise about delays caused by POCUS. Consider the data from Clattenburg's post implementation study for the CASA protocol that showed a 4s reduction in pulse check duration after CASA was implemented (PMID: 30071262). Also consider the COACHRED protocol that integrates POCUS to a cardiac arrest (PMID: 31456338) Have you considered a recent papers that advocates for continuous intra-arrest POCUS during CPR and pulse checks (PMID: 31150302) Also, consider how intra-arrest POCUS may be beneficial to optimise the position for CPR for individual patients (PMID: 27918847) I feel that this position statement may discourage POCUS users to consider this technology during a cardiac arrest I realise that I am a staunch supporter of POCUS and I am biased in favour of it's use Thank you again for all your hard work in compiling this review -
Виктория Антонова
After 37 years in the NICU I have seen complications from IO placement .I believe UVC access is superior in our population. The neo performing this task are very adept at securing a line quickly and administration of medications is delivered in a timely manner -
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
It already says: "We suggest umbilical venous catheterization as the preferred vascular access during newborn resuscitation" -
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
In my opinion, umbilical cord venous access should be first line. IO access in neonates is associated with high rates of incorrect placement.