Neonatal Resuscitation

Most infants transition from intrauterine to extrauterine life without any assistance. The term-infant with good tone, color, and respiratory effort requires no assistance and should be handed off to the mother after birth. However, approximately 10% of infants require some resuscitation and about 1% require extensive resuscitation.  The main priority in neonatal resuscitation is establishment of effective ventilation and oxygenation.

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2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC)

The 2020 Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) are a comprehensive revision of the AHA’s guidelines for adult, pediatric, neonatal, resuscitation education science, and systems of care topics. They have been developed for resuscitation providers and AHA instructors to focus on the resuscitation science and guidelines recommendations that are most significant or controversial, or those that will result in resuscitation training and practice changes and provide the rationale for the recommendations.

Highlights

“Top 10 Changes” Project: CPR & ECC Guidelines Infographic Series

2020 AHA Algorithms

American Heart Association Guidelines for CPR & Emergency Cardiovascular Care 2017

 

These highlights summarize the key issues and changes in the adult and pediatric basic life support (BLS) 2017 focused updates to the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC).

 

Post ROSC

System Action
Airway Intubate → Ventilation tidal volume @ 6-8 mL/kg
Place OG or NG tube
Confirm endotracheal and OG/NG tube placement with chest x-ray
Breathing SpO2 goal >94% → adjust PEEP & FiO2 to achieve goal
EtCO2 goal 30-40 mmHg → adjust respiratory rate to achieve
Circulation 12-lead ECG → Activate cardiac catheterization lab for STEMI; consult cardiology for all other patients
SBP goal >90 mmHg (MAP > 65 mmHg) → Use fluids, norepinephrine infusion, then epinephrine infusion to achieve goal
Place central line
Place arterial line
Perform point of care ultrasound with the cardiac, lung, and IVC views
Send labs, which includes an arterial blood gas and serum lactate
Place Foley catheter → Goal urine output 0.5-1 mL/kg/hr
Consider CT chest angiography to rule-out a pulmonary embolism
Disability Begin cooling → Goal temperature 32–36°C
Consider head CT

 

 

 

The Crashing Infant

  1. Call for help.
  2. Take out the Broselow tape.
  3. Get the child on the monitor and check the vital signs.
  4. Apply oxygen.
  5. Obtain vascular access.
  6. Check a sugar (and treat as necessary).
  7. Treat for infection.

 

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When it’s time to call off the resuscitation…

When to call it off

 

CEASE: (look for)

  • Clinical features that predict survival; (evaluate the)
  • Effectiveness of resuscitation efforts;
  • Ask the other clinicians present;
  • Stop resuscitation efforts;
  • Explain what has happened to the family.