Recent discussions
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ILCOR Staff
I am sorry but I am unable to follow your reasoning or indeed the point you are trying to make. Are you suggesting that the guidelines and evidence evaluated and presented is incorrect? You seem to be suggesting that guidelines are harming although the papers you quote actually show reduced neonatal, childhood and adolescent death and morbidity. However, the reduction in neonatal issues was less than in other age groups, but is was still an improvement. I am not clear how our evaluation of the evidence in this PICOST can change that fact but implementation of evidence based guidelines must be the correct way forward? -
ILCOR Staff
I agree with the recommendations of starting at room air, 21%. -
ILCOR Staff
My humble request to you all: Report from 195 countries suggest children are suffering from hypoxia during birth and suffering from brain damages and exponential rise of Autism PLEASE SAVE THE CHILDREN IN THIS WORLD NOW AND MAKE A BETTER WORLD FOR TOMORROW . NEWBORN BLUE BABIES HAVE BEEN SUFFERING FROM HYPOXIA ( LOW OXYGEN ) INJURIES TO THEIR BRAIN, BEGAN IN 2006 AND MUST END NOW. THE TIME HAS COME TO CHANGE THE NRP/ILCOR/ANZCOR/ EUROPEAN NEWBORN RESUSCITATION COMMITTEES GUIDELINES IMMEDIATELY # REPORT FROM 195 COUNTRIES ( FROM 1990 TO 2015 ) ; GLOBAL BURDEN OF DISEASES ( GBD ) AND DEATHS FROM PRETERM BIRTH COMPLICATIONS, LOWER RESPIRATORY INFECTIONS, BIRTH ASPHYXIA, TRAUMA, CANCERS AND EXPONENTIAL RISE OF AUTISM. 90% newborn babies are pink within 1 minute. Why remaining 10% will suffer ? We are supposed to help them in the delivery room. # Care for Autism and Other Disabilities — A Future in Jeopardy ( USA ) http://jamanetwork.com/journals/jamapediatrics/fullarticle/2613463?utm_medium=alert&utm_source=JAMA%20PediatrPublishAheadofPrint&utm_campaign=03-04-2017 http://jamanetwork.com/journals/jamapediatrics/fullarticle/2613461?utm_medium=alert&utm_source=JAMA%20PediatrPublishAheadofPrint&utm_campaign=03-04-2017 http://www.nejm.org/doi/full/10.1056/NEJMp1700697?query=pediatrics -
ILCOR Staff
I Agree with the treatment recommendations. -
ILCOR Staff
Thank you for the review. I agree with the recommendation. -
ILCOR Staff
Thank you for the distinct Review. I agree with the recommendations. Nevertheless, it is somehow disappointing how uncertain we still are on that topic (in regard to quality of evidence). -
ILCOR Staff
Thank you. Your point is well made and really needs to be addressed by: 1. Evidence that of slow increase perhaps from video assessments which are more common now. 2. Regional guidelines to address this pragmatic problem. Whilst your approach is understandable there is no evidence to support it at resent and this PICOST was only addressing initial oxygen concentration. As some others have suggested, when more evidence is available, we need to address issues such as increasing and weaning oxygen concentrations. -
ILCOR Staff
This recommendation does not prevent that approach as it was not addressed by the PICOST. However, there is no evidence in terms of the outcomes assessed to either support or refute the approach you suggest. It is interesting that in the RESAIR studies as many babies were switched to air from 100% oxygen as the reverse. However, those studies were not performed in the era of widespread saturation assessment. It may be that more data will become available on HR response with the wider use of ECG. -
ILCOR Staff
Thank you as in my comments above: this recommendation does not rule out increasing the concentration of oxygen as it refers to the starting concentration. Your suggestion of starting at 30-40% in secondary apnoea and subsequent increases is interesting but there is no evidence to support or refute such an approach. We are therefore not able to comment upon this in our recommendation. -
ILCOR Staff
Thank you. Unfortunately the PICOST only addressed the initial oxygen concentration at which to commence resuscitation. In 2015 the timing of any increase in concentration was addressed and there was no human and conflicting animal data. It was a consensus agreement that it was reasonable to increase the concentration of oxygen if the heart rate did not respond to adequate ventilation and should be increased if compressions were commenced if it had not occurred before. More evidence is of course required