2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Wyckoff, Myra H.; Weiner, Gary M.

doi:10.1542/peds.2020-038505c

Cited by 81 publications

(115 citation statements)

References 148 publications

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“…7À9 Neonatal Life Support 2020 preferred umbilical venous catheterisation as the primary method of vascular access but an IO route seems a "reasonable alternative" during resuscitation. 10 There are few answers to the question: "What is the potentially best area for neonatal IO access?". This can be attributed to both limited knowledge of newborn bony and vascular anatomy and limited studies in this area.…”

Section: Introductionmentioning

confidence: 99%

Finding alternative sites for intraosseous infusions in newborns

et al. 2021

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Aim: Intraosseous (IO)-access plays an alternative route during resuscitation. Our study in preterm and term stillborns was performed to find alternative IO puncture sites beside the recommended proximal tibia. Methods:The cadavers used were legal donations. 20 stillborns (mean: 29.2weeks, IQR 27.1À39.6) were investigated. Spectral-CT were analysed to calculate the diameter and circumferences of: i) proximal humerus ii) distal femur iii) proximal tibia iv) diaphyseal tibial. Contrast medium was applied under video documentation to investigate the drainage into the vascular system.Results: In term newborns, diameter of the cortex of the proximal humeral head is 12.1 AE 1.8 mm, distal end of the femur 11.9 AE 3.4 mm and the proximal tibial bone 12.0 AE 2.4 mm with cross-sectional diameter of 113.5 AE 19.7 mm 2 , 120.6 AE 28.2 mm 2 and 111.6 AE 29.5 mm 2 , respectively. Regarding the preterm groups, there is a strong age-related growth in diameter and cross -sectional size. The diaphyseal area is the smallest in all measured bones with an age-dependent increase and is about half of that of metaphyseal diameters (proximal and distal) and about one third of that of metaphyseal cross sectional areas. The proximal femoral head region has the largest diameter of all measured bones with an egg-shaped formation with an extensive joint capsula. All investigated metaphyseal areas lack a clearly enclosed bone marrow cavity. Infusion of contrast medium into the distal femoral end and the proximal humerus head demonstrate the drainage of contrast medium into the central venous system within seconds. Conclusion:Proximal humeral head and distal femoral end might be alternative IO areas which may lead to further IO puncture sites in neonates.

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Section: Introductionmentioning

confidence: 99%

Finding alternative sites for intraosseous infusions in newborns

et al. 2021

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“…Eine subgaleale Blutung sollte auch ohne Zeichen eines Schocks sofort und umfassend behandelt werden. Nach der zweimaligen Gabe von kristalloidem Volumen (20 ml/kg KG) sollte rasch die Transfusion von Erythrozytenkonzentraten (mindestens 10–20 ml/kg KG) erfolgen 17 18 19 20 . Gleichzeitig ist die sofortige Behandlung der sekundären Gerinnungsstörung unabdingbar.…”

Section: Diskussionunclassified

Das subgaleale Hämatom beim Neugeborenen – ein neonatologischer Notfall

Andresen

Zieger

Würtemberger

et al. 2021

Z Geburtshilfe Neonatol

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ZUSAMMENFASSUNGDas subgaleale Hämatom (SGH) ist eine seltene Geburtskomplikation des Neugeborenen und kann aufgrund des erheblichen Blutverlustes in den subgalealen Raum zu einem hämorrhagischen Schock führen. Wir berichten von zwei Neugeborenen, die ein subgaleales Hämatom mit schwerem hämorrhagischem Schock und Enzephalopathie entwickelten. Im ersten Fall eines reifen weiblichen Neugeborenen wurde die Entstehung des subgalealen Hämatoms durch eine Neugeboreneninfektion und die Geburt mittels Vakuumextraktion begünstigt. Der zweite Fall eines männlichen Frühgeborenen wurde durch eine schwierige Kindsentwicklung mittels sekundärer Sectio caesarea kompliziert. Neben der raschen Behandlung des Schocks ist vor allem die Therapie der Gerinnungsstörung essentiell. Beide Fälle verdeutlichen, dass das subgaleale Hämatom ein neonatologischer Notfall ist.

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“…Currently, epinephrine is the only medication recommended in neonatal resuscitation 1 and is indicated if the heart rate remains below 60 beats per minute (bpm) despite effective positive pressure ventilation (PPV) with 100% O 2 and chest compressions (CC). 2 3 Time to return of spontaneous circulation (ROSC) is an important prognostic indicator of outcome.…”

Section: Introductionmentioning

confidence: 99%

Randomised trial of epinephrine dose and flush volume in term newborn lambs

Sankaran

Chandrasekharan

Gugino

et al. 2021

Arch Dis Child Fetal Neonatal Ed

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ObjectivesNeonatal resuscitation guidelines recommend 0.5–1 mL saline flush following 0.01–0.03 mg/kg of epinephrine via low umbilical venous catheter for persistent bradycardia despite effective positive pressure ventilation (PPV) and chest compressions (CC). We evaluated the effects of 1 mL vs 3 mL/kg flush volumes and 0.01 vs 0.03 mg/kg doses on return of spontaneous circulation (ROSC) and epinephrine pharmacokinetics in lambs with cardiac arrest.DesignForty term lambs in cardiac arrest were randomised to receive 0.01 or 0.03 mg/kg epinephrine followed by 1 mL or 3 mL/kg flush after effective PPV and CC. Epinephrine (with 1 mL flush) was repeated every 3 min until ROSC or until 20 min. Haemodynamics, blood gases and plasma epinephrine concentrations were monitored.ResultsTen lambs had ROSC before epinephrine administration and 2 died during instrumentation. Among 28 lambs that received epinephrine, 2/6 in 0.01 mg/kg-1 mL flush, 3/6 in 0.01 mg/kg-3 mL/kg flush, 5/7 in 0.03 mg/kg-1 mL flush and 9/9 in 0.03 mg/kg-3 mL/kg flush achieved ROSC (p=0.02). ROSC was five times faster with 0.03 mg/kg epinephrine compared with 0.01 mg/kg (adjusted HR (95% CI) 5.08 (1.7 to 15.25)) and three times faster with 3 mL/kg flush compared with 1 mL flush (3.5 (1.27 to 9.71)). Plasma epinephrine concentrations were higher with 0.01 mg/kg-3 mL/kg flush (adjusted geometric mean ratio 6.0 (1.4 to 25.7)), 0.03 mg/kg-1 mL flush (11.3 (2.1 to 60.3)) and 0.03 mg/kg-3 mL/kg flush (11.0 (2.2 to 55.3)) compared with 0.01 mg/kg-1 mL flush.Conclusions0.03 mg/kg epinephrine dose with 3 mL/kg flush volume is associated with the highest ROSC rate, increases peak plasma epinephrine concentrations and hastens time to ROSC. Clinical trials evaluating optimal epinephrine dose and flush volume are warranted.

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2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Cited by 81 publications

References 148 publications

Finding alternative sites for intraosseous infusions in newborns

Finding alternative sites for intraosseous infusions in newborns

Das subgaleale Hämatom beim Neugeborenen – ein neonatologischer Notfall

Randomised trial of epinephrine dose and flush volume in term newborn lambs

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