Pulseless Electrical Activity Complicating Neonatal Resuscitation

Sillers, Laura; Handley, Sara C.; James, Jennifer; Foglia, Elizabeth E.

doi:10.1159/000493357

Cited by 26 publications

(19 citation statements)

References 8 publications

(9 reference statements)

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“…These studies indicate that cardiac arrest in the presence of a nonperfusing cardiac rhythm is common in asphyxiated neonatal piglets. Furthermore, this animal data is in agreeance with clinical observations of reduced CPR success in the presence of PEA in the delivery room in newborn infants [15,16].…”

Section: Pulseless Electrical Activity In the Porcine Model Of Neonatsupporting

confidence: 89%

“…It is possible that PEA may be common in asphyxiated newborns but has been undetected in the clinical setting prior to the recent use of ECG in the delivery room. Recent case reports have raised concerns over the reliability of ECG use during neonatal resuscitation, and the detection of PEA has been cited as a potential limitation of ECG use to guide delivery room resuscitation [15,16]. Data from studies in the pediatric population indicate decreased survival following resuscitation with PEA events [17,18], however this is inconsistent throughout the literature.…”

Section: Pulseless Electrical Activitymentioning

confidence: 99%

“…Data from studies in the pediatric population indicate decreased survival following resuscitation with PEA events [17,18], however this is inconsistent throughout the literature. Recent case studies in newborn infants presenting with cardiac arrest with PEA rhythm, as indicated on ECG [15,16], suggest dire outcomes. Further studies (animal and prospective clinical) are needed to determine the cause and actual incidence of PEA in order to improve the survival of newborns experiencing PEA in the delivery room.…”

Section: Pulseless Electrical Activitymentioning

confidence: 99%

See 2 more Smart Citations

A Porcine Model of Neonatal Hypoxia-Asphyxia to Study Resuscitation Techniques in Newborn Infants

O’Reilly¹,

Cheung²,

Lee³

et al. 2020

Animal Models in Medicine and Biology

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Two to three million newborn infants worldwide need extensive cardiopulmonary resuscitation (CPR), and approximately one million of these infants die annually worldwide. Therefore, resuscitation techniques require further refinement to provide better outcomes. To investigate the effectiveness of various interventions and to understand the pathophysiology and pharmacology of neonatal CPR, it is important to have animal models that reliably reproduce features observed in neonates who require resuscitation. Herein, we describe an experimental animal model in newborn piglets that simulates neonatal asphyxia and enables us to examine resuscitation interventions, reoxygenation, and recovery processes. The newborn piglet has several advantages including similar development to a human fetus at 36-38 week's gestation, and comparable body systems and body size, allowing for surgical instrumentation, monitoring, and collection of biological samples. Furthermore, using this model of neonatal asphyxia, we are also able to describe an increasingly important clinical situation in the laboratory setting-pulseless electrical activity (PEA). Since the integration of electrocardiogram into the neonatal resuscitation guidelines, there has been an increased awareness of PEA in newborn infants. The animal model we describe can therefore serve as a valuable tool to bridge the knowledge gap and improve the outcome of asphyxiated newborns in the delivery room.

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Section: Pulseless Electrical Activity In the Porcine Model Of Neonatsupporting

confidence: 89%

Section: Pulseless Electrical Activitymentioning

confidence: 99%

Section: Pulseless Electrical Activitymentioning

confidence: 99%

See 1 more Smart Citation

A Porcine Model of Neonatal Hypoxia-Asphyxia to Study Resuscitation Techniques in Newborn Infants

O’Reilly¹,

Cheung²,

Lee³

et al. 2020

Animal Models in Medicine and Biology

View full text Add to dashboard Cite

show abstract

“…Two studies report that the ECG displayed a HR during PEA in 40-50% of asphyxiated newborn piglets [48,49]. There have been one case report and a case series totaling seven cases of PEA in the delivery room during neonatal resuscitation [50][51][52][53]. This is concerning, especially if healthcare professionals are relying exclusively on the ECG signal.…”

Section: Pulseless Electrical Activitymentioning

confidence: 99%

Heart Rate Assessment during Neonatal Resuscitation

Johnson

Schmölzer

2020

Healthcare

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Approximately 10% of newborn infants require some form of respiratory support to successfully complete the fetal-to-neonatal transition. Heart rate (HR) determination is essential at birth to assess a newborn’s wellbeing. Not only is it the most sensitive indicator to guide interventions during neonatal resuscitation, it is also valuable for assessing the infant’s clinical status. As such, HR assessment is a key step at birth and throughout resuscitation, according to recommendations by the Neonatal Resuscitation Program algorithm. It is essential that HR is accurate, reliable, and fast to ensure interventions are delivered without delay and not prolonged. Ineffective HR assessment significantly increases the risk of hypoxic injury and infant mortality. The aims of this review are to summarize current practice, recommended techniques, novel technologies, and considerations for HR assessment during neonatal resuscitation at birth.

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“…In addition, two case reports reported pulseless electrical activity (PEA) in newborn infants. One followed placement of a central catheter resulting in cardiac tamponade7 and the second occurred during neonatal resuscitation 8. Furthermore, we have reported two animal studies with cardiac arrest with PEA rhythm, where ECG displayed an HR ranging between 15/min and 80/min in 23/549 and 22/3010 asphyxiated piglets.…”

Section: Introductionmentioning

confidence: 99%

Cardiac arrest with pulseless electrical activity rhythm in newborn infants: a case series

Luong

Cheung

Barrington

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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The 2015 neonatal resuscitation guidelines added ECG to assess an infant’s heart rate when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room. We report four cases of pulseless electrical activity during neonatal cardiopulmonary resuscitation in levels II–III neonatal intensive care units in Canada (Edmonton [n=3] and Winnipeg [n=1]).Healthcare providers should be aware that pulseless electrical activity can occur in newborn infants during cardiopulmonary resuscitation. We propose an adapted neonatal resuscitation algorithm to include pulseless electrical activity. Furthermore, in compromised newborns, heart rate should be assessed using a combination of methods/techniques to ensure accurate heart rate assessment. When ECG displays a heart rate but the infant is unresponsive, pulseless electrical activity should be suspected and chest compression should be started.

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Pulseless Electrical Activity Complicating Neonatal Resuscitation

Cited by 26 publications

References 8 publications

A Porcine Model of Neonatal Hypoxia-Asphyxia to Study Resuscitation Techniques in Newborn Infants

A Porcine Model of Neonatal Hypoxia-Asphyxia to Study Resuscitation Techniques in Newborn Infants

Heart Rate Assessment during Neonatal Resuscitation

Cardiac arrest with pulseless electrical activity rhythm in newborn infants: a case series

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