Recent discussions
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Виктория Антонова
Since the NRP statement was publicized I have been concerned about the absolute interpretations of the wording “ROUTINE suctioning is no longer RECOMMENDED” in the depressed infant born through MSAF. In our institution it was taken as an absolute, that no baby should EVER be suctioned below the cords and those of us with many decades of experience who are expert intubators were rebuked harshly for doing so. I am very concerned that the statement has been taken too literally and that it should be reworded in such a way as to give an experienced provider the option without subsequent scorn. -
Виктория Антонова
Since the NRP statement was publicized I have been concerned about the absolute interpretations of the wording “ROUTINE suctioning is no longer RECOMMENDED” in the depressed infant born through MSAF. In our institution it was taken as an absolute, that no baby should EVER be suctioned below the cords and those of us with many decades of experience who are expert intubators were rebuked harshly for doing so. I am very concerned that the statement has been taken too literally and that it should be reworded in such a way as to give an experienced provider the option without subsequent scorn. -
Виктория Антонова
I agree with the findings of the review -
Виктория Антонова
The routine suctioning of non-vigorous infants after meconium aspiration can be perfomed once and both, tracheal suction and intubation must be a priority in these cases . -
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 -
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 -
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. -
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. -
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. . -
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.