Outcome of Extremely Low Birth Weight Infants Who Received Delivery Room Cardiopulmonary Resuscitation

Wyckoff, Myra H.; Salhab, Walid A.; Heyne, Roy J.; Kendrick, Douglas E.; Stoll, Barbara J.; Laptook, Abbot R.

doi:10.1016/j.jpeds.2011.07.041

Cited by 118 publications

(88 citation statements)

References 26 publications

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“…Asphyxia also impairs cerebral autoregulation, so the brain cannot maintain cerebral blood flow at a near steady state, leaving the brain more vulnerable to cardiovascular hemodynamic instability and hemorrhagic injury (32,33). Therefore, these rapid fluctuations to cerebral blood flow may partially explain why infants given cardiopulmonary resuscitation have poor neurological outcomes and increased risk of developing grade 3 or 4 intraventricular hemorrhages (34).…”

Section: Discussionmentioning

confidence: 99%

Effects of chest compressions on cardiovascular and cerebral hemodynamics in asphyxiated near-term lambs

et al. 2015

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Background: Chest compressions (CC) and adrenaline administration are recommended in asphyxiated newborns with persistent bradycardia despite effective ventilation. The effects of CC on cerebral blood flow in newborns at birth are unknown. Our aim was to determine the effects of CC, with or without adrenaline administration, on the return of spontaneous circulation, carotid blood flow (CBF), and carotid arterial pressure (CAP) in asphyxiated near-term lambs. Methods: Asphyxia was induced in near-term lambs by clamping the umbilical cord and delaying ventilation onset until spontaneous circulation ceased. Lambs were then resuscitated by positive pressure ventilation along with CC followed by adrenaline administration. CAP and CBF were continuously recorded. results: Mean CAP did not increase significantly during CC and only increased following adrenaline administration. CC did not increase mean CBF but increased CBF amplitude due to increased peak flow and the onset of retrograde flow during diastole. Adrenaline increased mean CBF from 1 ± 2 to 15 ± 5 ml/kg/min and abolished retrograde diastolic CBF, leading to the return in spontaneous circulation. conclusion: We conclude that CC with adrenaline administration was required to increase CBF and restore spontaneous circulation in asphyxiated lambs. Low CBF and retrograde diastolic CBF during CC indicate hypoperfusion to the brain. a pproximately 5% of all newborns worldwide will require some form of assisted ventilation at birth and about 0.03% of newborns will require more advanced resuscitation such as intubation, chest compressions (CCs), and drug administration (1,2). Severely asphyxiated newborn infants are born bradycardic and apneic and require resuscitation to establish pulmonary gas exchange and restore cardiac function after birth. As the initiation of ventilation and the establishment of a functional capacity also trigger the increase in pulmonary blood flow at birth, it plays a dual role in severely asphyxiated newborn infants (3). That is, it is responsible for both increasing oxygenation and for facilitating the increase in cardiac output by providing preload for the left ventricle (3,4). If low cardiac output persists despite effective positive pressure ventilation, the newborn is likely to suffer increasingly severe hypoxia and acidemia, leading to hypoxic/ischemic injury. Continued asphyxia further depresses myocardial function, leading to low systolic and diastolic blood pressures despite a chemoreceptor-mediated peripheral vasoconstriction (5,6). Current international neonatal resuscitation guidelines recommend that if heart rate is less than 60 BPM despite effective positive pressure ventilation, CCs should be applied (7,8). CC will assist to mechanically pump blood until the myocardium is sufficiently oxygenated to recover spontaneous function (9). If heart rate remains below 60 BPM despite effective CC, then adrenaline should be administered (7,8).Given the infrequent use of CC and adrenaline, rigorous clinical studies to optimize CC and adren...

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Section: Discussionmentioning

confidence: 99%

Effects of chest compressions on cardiovascular and cerebral hemodynamics in asphyxiated near-term lambs

et al. 2015

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“…Heart rate before the commencement of CC was also comparable between groups 53 (15-62) bpm in the 3:1 group versus 42 (15-49) bpm in the SI group, respectively (P=0.490). Table 1 represents values of pH, pco 2 , lactate, and hemoglobin at the start of CPR (end of asphyxia), and the values of pH, pco 2 , and lactate after reestablishment of ROSC, as well.…”

Section: Resultsmentioning

confidence: 99%

“…A lthough chest compressions (CCs) are an infrequent event in newly born infants (≈0.08% for near-term and term deliveries), 1,2 outcome studies of delivery room resuscitations have reported high rates of mortality and neurodevelopmental impairment in those infants receiving CC or epinephrine. 1,2 The poor prognosis associated with receiving cardiac compressions alone or with medications in the delivery room raises questions as to whether improved cardiopulmonary resuscitation (CPR) methods specifically tailored to the newborn could improve outcomes.…”

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confidence: 99%

“…1,2 The poor prognosis associated with receiving cardiac compressions alone or with medications in the delivery room raises questions as to whether improved cardiopulmonary resuscitation (CPR) methods specifically tailored to the newborn could improve outcomes. 3 Current resuscitation guidelines recommend a 3:1 compression:ventilation (C:V) ratio; however, the most effective C:V ratio in newborns remains controversial.…”

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confidence: 99%

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Cardiopulmonary Resuscitation With Chest Compressions During Sustained Inflations

et al. 2013

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Background-Guidelines on neonatal resuscitation recommend 90 chest compressions (CCs) and 30 manual inflations (3:1) per minute in newborns. The study aimed to determine whether CC s during sustained inflations (SIs) improves the recovery of asphyxiated newborn piglets in comparison with coordinated 3:1 resuscitation. Methods and Results-Term newborn piglets (n=8/group) were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by asphyxia. Piglets were randomly assigned to receive either 3:1 resuscitation (3:1 group) or CCs during SIs (SI group) when the heart rate decreased to 25% of baseline.

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“…In children between one and and 8 years old and in adults, the compression must be performed with the hypothenar region of one hand on the sternum, with compression 5 cm deep 12 .…”

Section: () the Sudden Loss Or Interruption Of The Cardiovascular mentioning

confidence: 99%

Knowledge, Attitudes and Nursing Practices on Cardiorespiratory Arrest in Neonatal Intermediate Care Unit: A Qualitative Study in the Northeast of Brazil

Abrantes¹,

Coura²,

Bezerra

et al. 2015

J. Hum. Growth Dev.

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Outcome of Extremely Low Birth Weight Infants Who Received Delivery Room Cardiopulmonary Resuscitation

Cited by 118 publications

References 26 publications

Effects of chest compressions on cardiovascular and cerebral hemodynamics in asphyxiated near-term lambs

Effects of chest compressions on cardiovascular and cerebral hemodynamics in asphyxiated near-term lambs

Cardiopulmonary Resuscitation With Chest Compressions During Sustained Inflations

Knowledge, Attitudes and Nursing Practices on Cardiorespiratory Arrest in Neonatal Intermediate Care Unit: A Qualitative Study in the Northeast of Brazil

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