Recent discussions
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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. -
Виктория Антонова
IO access is not a well-established technique in newborns and most providers (at least in my practice settings) have little experience with it. UV should remain the overwhelmingly preferred route. -
Виктория Антонова
One important caveat is ictal-interictal continuum patterns, e.g. generalized periodic discharges with high frequency. Should clinicians consider anti-seizure medications? -
Maria Luce Caputo
It is a matter of fact that the technology is more and more improving the lay citizens' knowledge and involvment in the out-of-hospital cardiac arrest care. This review document by ILCOR summarize very well what we know right now about the impact of the mobile phones technology on the critical outcomes of OHCAs. However, more studies are needed to better assess some key points, including the use of the technology to select the person who has to retrieve the Automatic external defibrillator or the development of specific protocols of intervention in case of trauma or intoxication. -
Виктория Антонова
Thank you for taking the time to comment on this CoSTR. We acknowledge that an immediate replantation of an avulsed tooth substantially increases its survival and, hence, healing. However, this procedure may not be possible in the first aid setting due to the patient‘s concomitant injuries (e.g. unconsciousness, bleedings, fractures, …) at the time of accident and lack of knowledge in and willingness to undertake the management of such injuries. The use of a suitable temporary storage solution or technique for an avulsed tooth should not delay efforts at replantation, but it may aid in the survival of the tooth before receiving professional help. -
Виктория Антонова
Thank you for taking the time to comment on this CoSTR. For coconut water, there is conflicting evidence, and therefore no conclusion can be drawn and no recommendation for or against the use of coconut water can be made. In the 2015 CoSTR, egg white was recommended, based on 1 study showing a beneficial effect of egg white when compared with milk. In this recent update, an additional study was identified, and meta-analysis could no longer demonstrate a beneficial effect for egg white, when compared with milk. Therefore, a recommendation for or against egg white can no longer be made. -
Виктория Антонова
Thank you for taking the time to comment on this scoping review. ILCOR undertakes scoping reviews to search for evidence from well-designed scientific studies that might prompt a full systematic review. Thank you also for the two additional references. The first is an evidence based guideline from 2007 the results of which, for the first aid management of superficial burns, does not differ from that found in this scoping review. The second reference is a course aimed at healthcare professionals and the management of severe burns, both of which fall outside the limitations of this scoping review.