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.
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.
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).
| 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 |
CEASE: (look for)
