Recent discussions
-
Abdul Razak
I would like to urge reconsideration of the suggestion: “In term and late preterm infants who remain non-vigorous despite stimulation, we suggest intact cord milking (ICM) in preference to early cord clamping (ECC).” The evidence synthesis reveals no significant benefit or harm of ICM compared to ECC for mortality (risk ratio 0.11 [95% CI: 0.01–2.03]) & NICU admission (modeled odds ratio 0.69 [95% CI: 0.41–1.14]). However, ICM may show a potential clinical benefit in reducing moderate to severe hypoxic-ischemic encephalopathy (HIE) (RR 0.49 [95% CI: 0.25–0.97]) with moderate certainty. Notably, much of this evidence stems from a large multicenter cluster-randomized trial (Katheria 2024), which raises important concerns about the validity of these findings due to the inherent limitations of the study design. Cluster-randomized trials often face challenges as participants within a cluster tend to respond similarly, violating the assumption of independent data points. When this clustering effect is ignored, confidence intervals become artificially narrow, and p-values deceptively small, leading to potentially false-positive results. This issue was apparent in the trial by Katheria et al., where the primary outcome—NICU admission—appeared significantly lower with ICM than ECC (22.8% vs. 27.9%; crude OR 0.77 [95% CI: 0.62–0.95]). However, after adjusting for the cluster design, this effect became nonsignificant (adjusted OR 0.69 [95% CI: 0.41–1.14]). The stark difference between unadjusted and adjusted results underscores the profound impact of clustering on risk estimation, cautioning against overinterpreting crude estimates. Similarly, the study reported a significant reduction in moderate to severe HIE with cord milking compared to early clamping (1.4% vs. 3%; unadjusted RR 0.48 [95% CI: 0.24–0.96]). However, this outcome was not adjusted for the study design, likely due to low event rates. Given the absence of such adjustment and the usual lack of power to assess secondary outcomes in RCTs, it remains uncertain whether the observed effect on HIE is genuine or an artifact of the unaccounted clustering. This lack of robustness in the evidence raises concerns about the validity of prioritizing ICM over ECC based on unadjusted risks. Therefore, the recommendation to consider intact cord milking in preference to early cord clamping may be premature & potentially misleading, given the significant methodological limitations and the tenuous nature of the evidence.
-
Rita de Cassia Silveira
Level of initial supplemental oxygen delivered: according gestational age and for extreme preterm ( less than 28 wks GA. My suggestion is
- 31% to 50%
-
Daniela MEDEIROS
I agree starting with a lower oxygen concentration (21-30%) for preterms with more than 32 weeks
-
Angela Viau
In my country there are no personnel trained to use this POCUS technology, there are few doctors who know how to use it, in addition, in my point of view a lot of time is lost in resuscitation and can damage brain injuries.
-
marije hogeveen
Can you provide us with the search strategie used so we can check whether relevant new literature has been published for the ERC updates?
thank you in advance
-
Deepa Santhosh
Nice topic
-
Clément Derkenne
Although this item (BLS 2212) has been updated on November 11th, 2024, It seems surprising not to see in this topic the de Graaf studies (10.1016/j.resuscitation.2021.01.003.) and ours (10.1016/j.resuscitation.2024.110292). Both looked at technologies that analyze electrical rhythms during chest compressions. Both algorithms used these technologies either to extend the duration of CPR to 4 min if a non-shockable rhythm was detected (de Graaf et al.) or to shorten the duration of CPR to 1 min if a shockable rhythm was detected (Derkenne et al.). I might make sense that ILCOR positions it-self on these innovative solutions.
-
Marcos Almeida
we don’t have acess to videolarincoscope in my city. I never used this type, but i belive that this can be useful and bring benefits in nicu.
-
Janet Bray
Thank you for your comment. There is another PICOST that addresses checking for circulation during CPR. Janet Bray (BLS Chair)
-
Remi Garceau
Good day,
I was wondering if you have any clinical data that would indicate if the resuscitation that occured, if the providers was trained with QCPR feed back or not. We are telling groups like the Heart and stroke foundation that this should be impleted and yet, they are imposing it in the instructor guidelines.
Would it not be more concluent to have the QCPR feedback mandatory on all health care provider AED or manual AED? This would have a direct impact not on a dummy, but on a real person.
A provider is trained once per year with a QCPR, but all resuscitation could be done with a QCPR device and improve the quality on a real life person.
Thanks