European Resuscitation Council Guidelines for Resuscitation 2015

Wyllie, Jonathan; Bruinenberg, Jos; Roehr, Charles Christoph; Rüdiger, Mario; Trevisanuto, Daniele; Urlesberger, Berndt

doi:10.1016/j.resuscitation.2015.07.029

Cited by 435 publications

(243 citation statements)

References 311 publications

(332 reference statements)

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“…As effective PPV is the most important intervention during neonatal resuscitation, educational efforts should mainly concentrate on this task and it is essential that all those involved in the care of newborn infants at birth are able to perform this procedure 5.…”

Section: Discussionmentioning

confidence: 99%

“…Successful resuscitation could prevent a large proportion of these deaths and improve the outcomes of neonates surviving asphyxia 3, 4. Therefore, all birth attendants, including physicians, midwives and nurses, should have the knowledge and skills required to perform neonatal resuscitation 5. Providing effective positive pressure ventilation (PPV) is the single most important component of successful neonatal resuscitation 5.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, all birth attendants, including physicians, midwives and nurses, should have the knowledge and skills required to perform neonatal resuscitation 5. Providing effective positive pressure ventilation (PPV) is the single most important component of successful neonatal resuscitation 5. Ventilation is routinely initiated with face mask ventilation (FMV) followed by endotracheal intubation (ETT) in cases of FMV failure or the need for prolonged ventilatory support.…”

Section: Introductionmentioning

confidence: 99%

“…Important air leakages and airway blockage have been reported during FMV. Skilled staff are required when ETT is performed 5. The laryngeal mask airway (LMA) may be considered during resuscitation as an alternative to FMV or ETT for PPV in newborns weighing more than 2000 g or delivered around, or after, 34 weeks of gestation 5.…”

Section: Introductionmentioning

confidence: 99%

“…Skilled staff are required when ETT is performed 5. The laryngeal mask airway (LMA) may be considered during resuscitation as an alternative to FMV or ETT for PPV in newborns weighing more than 2000 g or delivered around, or after, 34 weeks of gestation 5. Several publications including a Cochrane review have shown that LMA achieved effective PPV in most of the treated patients, with a range of 95–99% 6, 7, 8, 9 and reduced the need for ETT 1, 10.…”

Section: Introductionmentioning

confidence: 99%

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Pilot manikin study showed that a supraglottic airway device improved simulated neonatal ventilation in a low‐resource setting

et al. 2016

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AimWe compared the performance of personnel in a low‐resource setting when they used the I‐gel cuffless neonatal laryngeal mask or a face mask on a neonatal airway management manikin.MethodsAt Mulago Hospital, Uganda, 25 doctors, nurses and midwives involved in neonatal resuscitation were given brief training with the I‐gel and face mask. Then, every participant was observed positioning both devices on three consecutive occasions. The success rate and insertion times leading to effective positive pressure ventilation (PPV) were recorded. Participants rated the perceived efficiency of the devices using a five‐point Likert scale.ResultsThe I‐gel achieved a 100% success rate on all three occasions, but the face mask was significantly less effective in achieving effective PPV and the failure rates at the first, second and third attempts were 28%, 8% and 20%, respectively. The perceived efficiency of the devices was significantly superior for the I‐gel (4.7 ± 0.4) than the face mask (3.3 ± 0.8).ConclusionThe I‐gel was more effective than the face mask in establishing PPV in the manikin, and user satisfaction was higher. These encouraging manikin data could be a stepping stone for clinical research on the use of the I‐gel for neonatal resuscitation in low‐resource settings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pilot manikin study showed that a supraglottic airway device improved simulated neonatal ventilation in a low‐resource setting

et al. 2016

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Effect of Sustained Inflations vs Intermittent Positive Pressure Ventilation on Bronchopulmonary Dysplasia or Death Among Extremely Preterm Infants

Kirpalani

Ratcliffe

Keszler

et al. 2019

JAMA

142

152

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Preterm infants must establish regular respirations at delivery. Sustained inflations may establish lung volume faster than short inflations. OBJECTIVE To determine whether a ventilation strategy including sustained inflations, compared with standard intermittent positive pressure ventilation, reduces bronchopulmonary dysplasia (BPD) or death at 36 weeks' postmenstrual age without harm in extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS Unmasked, randomized clinical trial (August 2014 to September 2017, with follow-up to February 15, 2018) conducted in 18 neonatal intensive care units in 9 countries. Preterm infants 23 to 26 weeks' gestational age requiring resuscitation with inadequate respiratory effort or bradycardia were enrolled. Planned enrollment was 600 infants. The trial was stopped after enrolling 426 infants, following a prespecified review of adverse outcomes. INTERVENTIONS The experimental intervention was up to 2 sustained inflations at maximal peak pressure of 25 cm H 2 O for 15 seconds using a T-piece and mask (n = 215); standard resuscitation was intermittent positive pressure ventilation (n = 211). MAIN OUTCOME AND MEASURES The primary outcome was the rate of BPD or death at 36 weeks' postmenstrual age. There were 27 prespecified secondary efficacy outcomes and 7 safety outcomes, including death at less than 48 hours. RESULTS Among 460 infants randomized (mean [SD] gestational age, 25.30 [0.97] weeks; 50.2% female), 426 infants (92.6%) completed the trial. In the sustained inflation group, 137 infants (63.7%) died or survived with BPD vs 125 infants (59.2%) in the standard resuscitation group (adjusted risk difference [aRD], 4.7% [95% CI, −3.8% to 13.1%]; P = .29). Death at less than 48 hours of age occurred in 16 infants (7.4%) in the sustained inflation group vs 3 infants (1.4%) in the standard resuscitation group (aRD, 5.6% [95% CI, 2.1% to 9.1%]; P = .002). Blinded adjudication detected an imbalance of rates of early death possibly attributable to resuscitation (sustained inflation: 11/16; standard resuscitation: 1/3). Of 27 secondary efficacy outcomes assessed by 36 weeks' postmenstrual age, 26 showed no significant difference between groups. CONCLUSIONS AND RELEVANCE Among extremely preterm infants requiring resuscitation at birth, a ventilation strategy involving 2 sustained inflations, compared with standard intermittent positive pressure ventilation, did not reduce the risk of BPD or death at 36 weeks' postmenstrual age. These findings do not support the use of ventilation with sustained inflations among extremely preterm infants, although early termination of the trial limits definitive conclusions.

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Delivery Room Resuscitation of Extremely Preterm Infants

Perlman

2019

JAMA

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European Resuscitation Council Guidelines for Resuscitation 2015

Cited by 435 publications

References 311 publications

Pilot manikin study showed that a supraglottic airway device improved simulated neonatal ventilation in a low‐resource setting

Pilot manikin study showed that a supraglottic airway device improved simulated neonatal ventilation in a low‐resource setting

Effect of Sustained Inflations vs Intermittent Positive Pressure Ventilation on Bronchopulmonary Dysplasia or Death Among Extremely Preterm Infants

Delivery Room Resuscitation of Extremely Preterm Infants

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