Recent discussions

  • Виктория Антонова

    The data to not suction are weak. I have observed and reviewed several deliveries with non-vigorous meconium stained babies. I have found suctioning to be helpful in the delivery room. SInce the new standards were in place, I have witnessed more issues after birth in the NICU. I think the motive to eliminate this step (suctioning) was more to protect hospitals for not having trained providers in the delivery room in cases of meconium stained fluid. Better to educate and train than keep dumbing down the standards. PLEASE AAP stop diluting the standards to appeal to the least common denominator. Having practiced neonatology for decades, I notice this is happening. Hold the line please.
    In following article:
    Tracheal suctioning of meconium at birth for non-vigorous infants: a systematic review and meta-analysis (NLS #865): Systematic Review
  • Виктория Антонова

    I would like to see outcomes relating to intubation stratified by "experience." I was trained in an era when all meconium stained infants (rightly or wrongly....mostly wrongly) were intubated. I wonder if, for those neonatologists that are still ACTIVELY practicing CLINICAL medicine, if their time to successful intubation and their percentage of successful first time attempts are higher than more junior practitioners that were trained in an era of decreased intervention (read - have had much less reps with intubation). That said, I wonder if ILCOR should look into these demographics and consider language that takes this into account (if the data supports that currently clinical active practitioners whose training occurred in the "intubate all meconium infants" are more adept at intubating than those practitioners who were trained in the "post- Wisell" era.
    In following article:
    Tracheal suctioning of meconium at birth for non-vigorous infants: a systematic review and meta-analysis (NLS #865): Systematic Review
  • Виктория Антонова

    After 40 years of neonatal nursing I knew this recommendation for "no tracheal suctioning" was not a good recommendation. I have always thought at least one suction pass was best and then intubation if necessary for time restraints. But NO suctioning was a bad idea for non-vigorous infants with thick meconium. I would like to see the recommendation be for one tracheal suction pass, and then intubation if needed. Several passes will delay intubation and possibly not clear the airway that much better, and no suctioning is not a good practice.
    In following article:
    Tracheal suctioning of meconium at birth for non-vigorous infants: a systematic review and meta-analysis (NLS #865): Systematic Review
  • Jasmeet Soar

    Thank-you for your feedback. I will discuss and consider all your comments with my colleagues on the ILCOR ALS Task Force and post a response in the next few weeks. Regards, Jas. Jasmeet Soar ALS Task Force Chair
    In following article:
    Vasopressors in Adult Cardiac Arrest (ALS): Systematic Review
  • Jasmeet Soar

    Thank-you for your feedback. I will discuss and consider all your comments with my colleagues on the ILCOR ALS Task Force and post a response in the next few weeks. Regards, Jas. Jasmeet Soar ALS Task Force Chair
    In following article:
    Advanced Airway Management During Adult Cardiac Arrest (ALS): Systematic Review
  • Виктория Антонова

    Good guidelines, except that you recommend supraglottic airway only in low intubation success settings. You suggest that the Wang and also Benger trials have low success rates (51.6% and 69.8%) and the Jabre as high (97.9%). So low success is more-or -less defined here as 50 to 70%? If a service has a success rate in the70’s or 80’s they would not be low by your informal definition. Should these services stick with intubation? I believe not. An intubation success rate in cardiac arrest that is anywhere in the 70’s or 80’s is still poor, and this tells you that these clinicians cannot competently use intubation. Only when success proportions approach mid to high 90’s such as in the Jabre trial can you say competent intubation takes place. I would prefer stronger recommendations here. If clinicians cannot intubate successfully (similar to Benger et al.) then they should be using supraglottic airways.
    In following article:
    Advanced Airway Management During Adult Cardiac Arrest (ALS): Systematic Review
  • Виктория Антонова

    A good attempt to bring clarity to a long standing problem. ABC is a well recognised mantra but in CA it’s the C in the form of continuous compressions that has proven benefits. I think this helps to concentrate attention on compressions and airway techniques employed depend upon the skill set of the operator. The gold standard remains tracheal intubation, in skilled hands. The BVM options of one or two hands could do with some good evidence to clarify the best way forward but likely again to be operator dependent particularly for those unfamiliar with the device.
    In following article:
    Advanced Airway Management During Adult Cardiac Arrest (ALS): Systematic Review
  • Виктория Антонова

    Is there any high-quality evidence comparing no airway intervention with any airway intervention which shows a significant improvement by adding an airway intervention? No. We need to stop creating problems that do not benefit the patients. Stop encouraging airway management where airway management has not been clearly demonstrated to improve outcomes over the passive ventilation provided by chest compressions only. .
    In following article:
    Advanced Airway Management During Adult Cardiac Arrest (ALS): Systematic Review
  • Виктория Антонова

    The CoSTR of airway was nicely written. It will give us a room in the national Resuscitation councils when writing the guidelines particularly for the out-of- hospital management of airway. With consideration of training of EMTs and Paramedics and the time of arrival of EMS services.
    In following article:
    Advanced Airway Management During Adult Cardiac Arrest (ALS): Systematic Review
  • Виктория Антонова

    Thank you to the committee for tackling this subject. Obviously, it is very difficult to make any recommendation based on what was written. There are no definitions of high vs low tracheal intubation success rates; the same conclusions were drawn for out-of-hospital cardiac arrest as for in-hospital cardiac arrest using the same patient population (I'm confused about how those numbers add up); and it's difficult to compare when the advanced airway management could have occurred at any time during the resuscitation attempt. Based on the 2010 guidelines, and reinforced in the 2015 guidelines, continuous chest compressions are a key to ROSC. Insertion of the advanced airway early in the resuscitation should therefor allow for an earlier onset of continuous compressions and should yield a higher rate of ROSC, and hopefully a higher discharge rate. In order to determine this, I believe we need to look at the sequence of events in a resuscitation and program them. Otherwise, we will continue to have "very low" evidence recommendations which really don't provide clinicians with much guidance.
    In following article:
    Advanced Airway Management During Adult Cardiac Arrest (ALS): Systematic Review
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