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Morin C, Lee TF, O'Reilly M, Cheung PY, Schmölzer GM. Continuous chest compression during sustained inflation versus continuous compression with asynchronized ventilation in an infantile porcine model of severe bradycardia. Resusc Plus 2024; 18:100629. [PMID: 38617441 PMCID: PMC11015518 DOI: 10.1016/j.resplu.2024.100629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
Background Recently, the American Heart Association released a statement calling for research examining the appropriate age to transition from the neonatal to pediatric cardiopulmonary resuscitation approach to resuscitation. Aim To compare neonatal and pediatric resuscitation approach by using either continuous chest compression with asynchronized ventilation (CCaV) or continuous chest compression superimposed with sustained inflation (CC + SI) during infant cardiopulmonary resuscitation. We hypothesized that CC + SI compared to CCaV would reduce time to return of spontaneous circulation (ROSC) in infantile piglets with asphyxia-induced bradycardic cardiac arrest. Methods Twenty infantile piglets (5-10 days old) were anesthetized and asphyxiated by clamping the endotracheal tube. Piglets were randomized to CC + SI or CCaV for resuscitation (n = 10/group). Heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, intrathoracic pressure and respiratory parameters were continuously recorded throughout the experiment. Main results The median (IQR) time to ROSC with CC + SI compared to CCaV was 179 (104-447) vs 660 (189-660), p = 0.05. The number of piglets achieving ROSC with CC + SI and CCaV were 8/10 and 6/10, p = 0.628. Piglets resuscitated with CC + SI required less epinephrine compared to CCaV (p = 0.039). CC + SI increased the intrathoracic pressure throughout resuscitation (p = 0.025) and increased minute ventilation (p < 0.001), compared to CCaV. There was no difference in hemodynamic parameters between groups. Conclusions CC + SI improves resuscitative efforts of infantile piglets by increasing the intrathoracic pressure and minute ventilation, and thus reducing the duration of resuscitation, compared to CCaV.
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Affiliation(s)
- Chelsea Morin
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tze-Fun Lee
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Megan O'Reilly
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Po-Yin Cheung
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Georg M. Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Ali N, Schierholz E, Reed D, Hightower H, Johnson BA, Gupta R, Gray M, Ades A, Wetzel EA. Identifying Gaps in Resuscitation Practices Across Level-IV Neonatal Intensive Care Units. Am J Perinatol 2024; 41:e180-e186. [PMID: 35617959 DOI: 10.1055/a-1863-2312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES This study aimed to describe resuscitation practices in level-IV neonatal intensive care units (NICUs) and identify possible areas of improvement. STUDY DESIGN This study was a cross-sectional cohort survey and conducted at the Level-IV NICUs of Children's Hospital Neonatal Consortium (CHNC). The survey was developed with consensus from resuscitation and education experts in the CHNC and pilot tested. An electronic survey was sent to individual site sponsors to determine unit demographics, resuscitation team composition, and resuscitation-related clinical practices. RESULTS Of the sites surveyed, 33 of 34 sites responded. Unit average daily census ranged from less than 30 to greater than 100, with the majority (72%) of the sites between 30 and 75 patients. A designated code response team was utilized in 18% of NICUs, only 30% assigned roles before or during codes. The Neonatal Resuscitation Program (NRP) was the exclusive algorithm used during codes in 61% of NICUs, and 34% used a combination of NRP and the Pediatric Advanced Life Support (PALS). Most (81%) of the sites required neonatal attendings to maintain NRP training. A third of sites (36%) lacked protocols for high-acuity events. A code review process existed in 76% of participating NICUs, but only 9% of centers enter code data into a national database. CONCLUSION There is variability among units regarding designated code team presence and composition, resuscitation algorithm, protocols for high-acuity events, and event review. These inconsistencies in resuscitation teams and practices provide an opportunity for standardization and, ultimately, improved resuscitation performance. Resources, education, and efforts could be directed to these areas to potentially impact future neonatal outcomes of the complex patients cared for in level-IV NICUs. KEY POINTS · Resuscitation practice is variable in level-IV NICUs.. · Resuscitation algorithm training is not uniform. · Standardized protocols for high-acuity low-occurrence (HALO) events are lacking.
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Affiliation(s)
- Noorjahan Ali
- Division of Perinatal-Neonatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth Schierholz
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, School of Medicine, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Danielle Reed
- Division of Perinatal-Neonatal Medicine, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, Missouri
| | - Hannah Hightower
- Division of Neonatology, Department of Pediatrics, Children's of Alabama, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Beth A Johnson
- Division of Neonatology and Pulmonary Biology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ruby Gupta
- Division of Neonatal/Perinatal Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Megan Gray
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Anne Ades
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth A Wetzel
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Sawyer T, McBride ME, Ades A, Kapadia VS, Leone TA, Lakshminrusimha S, Ali N, Marshall S, Schmölzer GM, Kadlec KD, Pusic MV, Bigham BL, Bhanji F, Donoghue AJ, Raymond T, Kamath-Rayne BD, de Caen A. Considerations on the Use of Neonatal and Pediatric Resuscitation Guidelines for Hospitalized Neonates and Infants: On Behalf of the American Heart Association Emergency Cardiovascular Care Committee and the American Academy of Pediatrics. Pediatrics 2024; 153:e2023064681. [PMID: 38105696 DOI: 10.1542/peds.2023-064681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/19/2023] Open
Abstract
Between 0.25% and 3% of admissions to the NICU, PICU, and PCICU receive cardiopulmonary resuscitation (CPR). Most CPR events occur in patients <1 year old. The incidence of CPR is 10 times higher in the NICU than at birth. Therefore, optimizing the approach to CPR in hospitalized neonates and infants is important. At birth, the resuscitation of newborns is performed according to neonatal resuscitation guidelines. In older infants and children, resuscitation is performed according to pediatric resuscitation guidelines. Neonatal and pediatric guidelines differ in several important ways. There are no published recommendations to guide the transition from neonatal to pediatric guidelines. Therefore, hospitalized neonates and infants can be resuscitated using neonatal guidelines, pediatric guidelines, or a hybrid approach. This report summarizes the current neonatal and pediatric resuscitation guidelines, considers how to apply them to hospitalized neonates and infants, and identifies knowledge gaps and future priorities. The lack of strong scientific data makes it impossible to provide definitive recommendations on when to transition from neonatal to pediatric resuscitation guidelines. Therefore, it is up to health care teams and institutions to decide if neonatal or pediatric guidelines are the best choice in a given location or situation, considering local circumstances, health care team preferences, and resource limitations.
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Affiliation(s)
- Taylor Sawyer
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Mary E McBride
- Divisions of Pediatric Cardiology and Pediatric Critical Care Medicine, Department of Pediatrics
| | | | - Vishal S Kapadia
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University Southwestern Medical Center, Dallas, Texas
| | - Tina A Leone
- Division of Neonatology, Department of Pediatrics, Columbia University, New York, New York
| | | | - Norjahan Ali
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University Southwestern Medical Center, Dallas, Texas
| | - Stephanie Marshall
- Neonatology, Department of Pediatrics, Northwestern University Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Kelly D Kadlec
- Division of Critical Care, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Martin V Pusic
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Blair L Bigham
- Division of Critical Care, Department of Anesthesia, Stanford University, Palo Alto, California
| | - Farhan Bhanji
- Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Aaron J Donoghue
- Pediatric Intensive Care, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tia Raymond
- Department of Pediatrics, Pediatric Cardiac Intensive Care, Medical City Children's Hospital, Dallas, Texas
| | - Beena D Kamath-Rayne
- Global Child Health and Life Support, American Academy of Pediatrics, Itasca, Illinois
| | - Allan de Caen
- Pediatric Critical Care, Department of Pediatrics, University of Alberta, Edmonton, Canada
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Qin H, Wang L, Yu B, Xing D, Su J, Bai Z. Effect of other venous access on cardiopulmonary resuscitation quality: A prospective, randomized, controlled trial. Biotechnol Genet Eng Rev 2023:1-11. [PMID: 37066803 DOI: 10.1080/02648725.2023.2199239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
This randomized controlled study aimed to prospectively evaluate the application effects of other venous access in patients undergoing cardiopulmonary resuscitation. A total of 212 patients who underwent respiratory and cardiac arrest were randomly divided into peripheral intravenous (IV) access group (IV group, n = 69), femoral vein catheterization group (FVC group, n = 72), and internal jugular vein catheterization group (IJVC group, n = 71). The puncture time, first administration time, pressure interruption time caused by the establishment of fluid pathway, endotracheal intubation time, complications, ROSC time, and ETCO2 were recorded. The time of establishing venous access was: IV<FVC<IJVC. The once puncture success rate of the FVC group was markedly higher than that in IV and IJVC groups (P < 0.01). There was no significant difference in ROSC time between the FVC, IV, and the IJVC group (P = 0.23). The ROSC time in the FVC group was higher than in the IV and IJVC groups (P < 0.01). The success rate of ROSC in the FVC group and IJVC group were better than that in the IV group (PVC>IJVC>IV, P = 0.04). There was no significant difference in EtCO2 between the FVC, IV group, and IJVC group (PVC>IJVC>IV, P = 0.17). Due to catheterization, the time of suspending chest compression in the FVC group was significantly lower than in the IJVC group (5s vs. 12s). The time of establishing an artificial airway in the IV (38s) and FVC (35s) group were significantly longer than that in IJVC (52s) group. Central venous catheterization is more effective than peripheral venous catheterization in cardiopulmonary resuscitation. Moreover, femoral vein access was more effective than internal jugular vein access.
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Affiliation(s)
- Hao Qin
- Emergency Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lantao Wang
- Emergency Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bin Yu
- Emergency Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Dong Xing
- Emergency Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jie Su
- Emergency Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zongjiang Bai
- Emergency Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Ali N, Sawyer T. Special consideration in neonatal resuscitation. Semin Perinatol 2022; 46:151626. [PMID: 35738945 DOI: 10.1016/j.semperi.2022.151626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Delivery room resuscitation of neonates is performed according to evidence-based neonatal resuscitation guidelines. Neonatal resuscitation guidelines focus on the resuscitation of newborns suffering from perinatal asphyxia. Special considerations are needed when resuscitating newborns in locations other than the delivery room and for newborns with congenital anomalies. In this review, we examine the resuscitation of newborns at home and in the emergency department and highlight special considerations for resuscitating newborns with specific congenital anomalies. In addition, we explore the resuscitation of neonates in the neonatal intensive care unit and discuss the potential use of pediatric advanced life support guidelines. Finally, we highlight the importance of simulation to prepare teams for neonatal resuscitations. This review aims to prepare healthcare professionals in all disciplines caring for neonates at risk for requiring resuscitation under special circumstances.
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Affiliation(s)
- Noorjahan Ali
- Department of Pediatrics Division of Perinatal-Neonatal Medicine UT Southwestern of Dallas Children's Medical Center of Dallas Texas, USA.
| | - Taylor Sawyer
- Department of Pediatrics Division of Neonatology, University of Washington School of Medicine Seattle Washington, USA
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Abstract
The goal of neonatal bioethics is to help clinicians navigate difficult decisions that arise every day in the care of critically ill newborns. Over the last few decades, there have been vigorous discussions of numerous ethical issues. For some, we have worked out a tentative societal agreement for appropriate responses. Others remain contentious and controversial. They evoke moral distress. In this article, we address some of these unresolved issues including the changing landscape of duration and viability threshold for newborn resuscitation, the issue of borderline of viability and the ethical controversies that arise when each center has its own policies, and some of the challenges that arise in Fetal Care Centers (FCC). Finally, we propose a generalizable model of shared decision making.
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Affiliation(s)
- Becky J Ennis
- Neonatologist, Associate Professor of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center
| | - Danielle Jw Reed
- Neonatologist, Associate Professor of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Mercy Hospital-Kansas City, University of Missouri-Kansas City School of Medicine.
| | - John D Lantos
- Director of the Children's Mercy Bioethics Center, Professor of Pediatrics, Department of Pediatrics, Children's Mercy Hospital-Kansas City, University of Missouri-Kansas City School of Medicine
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Best K, Wyckoff MH, Huang R, Sandford E, Ali N. Pulseless electrical activity and asystolic cardiac arrest in infants: identifying factors that influence outcomes. J Perinatol 2022; 42:574-579. [PMID: 35177792 DOI: 10.1038/s41372-022-01349-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/23/2022] [Accepted: 02/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is limited information on pulseless electrical activity (PEA)/asystolic cardiac arrest (CA) in the infant population. The aim is to describe the incidence and factors associated with outcomes in infants with PEA/asystolic CA. METHODS Single-center retrospective chart review study of infants less than one year of age who suffer in-hospital PEA/asystolic CA from January 1 2011 to June 30 2019. The primary outcome was the return of spontaneous circulation. The secondary outcome was survival to discharge. RESULTS CA occurred in 148 infants and PEA/asystolic was found in 38 (26%). Of those 29 (76%) achieved ROSC, and 12 (32%) survived to discharge. Infants on inotrope support or receiving longer duration of chest compressions and epinephrine had increase mortality. All infants with respiratory etiology of arrest survived to hospital discharge. CONCLUSION PEA/asystolic CAs are uncommon. Poor prognostic indicators include the need for pre-arrest inotrope support and increased duration of chest compressions.
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Affiliation(s)
- Kathryn Best
- UT Southwestern Medical Center Department of Pediatrics Division of Critical Care Medicine, Dallas, TX, USA
| | - Myra H Wyckoff
- UT Southwestern Medical Center Department of Pediatrics Division of Neonatal-Perinatal Medicine, Dallas, TX, USA
| | - Rong Huang
- Children's Medical Center Dallas Department of Biostatistics, Dallas, TX, USA
| | - Ethan Sandford
- UT Southwestern Medical Center Department of Pediatrics Division of Critical Care Medicine, Dallas, TX, USA
| | - Noorjahan Ali
- UT Southwestern Medical Center Department of Pediatrics Division of Neonatal-Perinatal Medicine, Dallas, TX, USA.
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Parikh P, Samraj R, Ogbeifun H, Sumbel L, Brimager K, Alhendy M, McElroy J, Whitt D, Henderson C, Bhalala U. Simulation-Based Training in High-Quality Cardiopulmonary Resuscitation Among Neonatal Intensive Care Unit Providers. Front Pediatr 2022; 10:808992. [PMID: 35356440 PMCID: PMC8959626 DOI: 10.3389/fped.2022.808992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/31/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION American Heart Association guidelines recommend the use of feedback devices for CPR provider resuscitation training. There is paucity of published literature regarding the utility of these devices especially in neonates and infants. We sought to evaluate if simulation-based education and debriefing using a CPR feedback device would improve CPR performance on an infant manikin in a cohort of NICU nurses as evaluated by CPR feedback device. METHODS We conducted a prospective, observational simulation study to assess the quality of chest compressions by NICU nurses before and after debriefing using CPR quality data captured by an accelerometer-based device. Chest compression (CC) depth, rate, recoil, CC fraction and nursing confidence level related to performing a high-quality CPR were compared before and after debriefing using paired t-test and Wilcoxon rank sum test. RESULTS A total of 62 NICU nurses participated in the study and all of them were Neonatal Resuscitation Program (NRP) certified. There was a significant improvement in CC depth and CC fraction [mean + SD values = 0.79 in + 0.17 (pre-debrief), 0.86 in + 0.21 (post-debrief) (p = 0.034) and 56.8% + 17.7 (pre-debrief), 70.8% + 18.4 (post-debrief) (0.0014), respectively]. There was no difference in CC rate (p = 0.36) and recoil (p = 0.25) between pre and post structured debriefing. The confidence level of nurses in all CPR dynamics (appropriate CC rate, CC depth, team communication, minimizing interruption in CC and coordinating CC with ventilation) was significantly higher after simulation and structured debriefing. All the nurses used 3:1 compression: ventilation ratio of NRP despite the patient being a 4 month old premature baby in the NICU. CONCLUSIONS Simulation training and debriefing of NICU nurses using CPR feedback device improved their chest compression quality on an infant mannequin and their confidence level for performing high-quality CPR. NICU providers tend to use NRP protocol of 3:1 compression: ventilation ratio during CPR in the NICU irrespective of age of the infant.
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Affiliation(s)
- Pratik Parikh
- The Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Ravi Samraj
- Driscoll Children's Hospital, Corpus Christi, TX, United States.,Department of Anesthesiology and Critical Care Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Henry Ogbeifun
- The Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Lydia Sumbel
- The Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Kelli Brimager
- The Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Mohammed Alhendy
- The Children's Hospital of San Antonio, San Antonio, TX, United States
| | - James McElroy
- The Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Dottie Whitt
- The Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Cody Henderson
- The Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Utpal Bhalala
- Driscoll Children's Hospital, Corpus Christi, TX, United States.,Department of Anesthesiology and Critical Care Medicine, University of Texas Medical Branch, Galveston, TX, United States.,Department of Pediatrics, Texas A&M University, College Station, TX, United States
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Coggins SA, Haggerty M, Herrick HM. Post-cardiac arrest physiology and management in the neonatal intensive care unit. Resuscitation 2021; 169:11-19. [PMID: 34648922 DOI: 10.1016/j.resuscitation.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 11/27/2022]
Abstract
AIM The importance of high-quality post-cardiac arrest care is well-described in adult and paediatric populations, but data are lacking to inform post-cardiac arrest care in the neonatal intensive care unit (NICU). The objective of this study was to describe post-cardiac arrest physiology and management in a quaternary NICU. METHODS Retrospective descriptive study of post-cardiac arrest physiology and management. Data were abstracted from electronic medical records and an institutional resuscitation database. A cardiac arrest was defined as ≥1 minute of chest compressions. Only index arrests were analysed. Descriptive statistics were used to report patient, intra-arrest, and post-arrest characteristics. RESULTS There were 110 index cardiac arrests during the 5-year study period from 1/2017-2/2021. The majority (69%) were acute respiratory compromise leading to cardiopulmonary arrest (ARC-CPA) and 26% were primary cardiopulmonary arrests (CPA). Vital sign monitoring within 24 hours post-arrest was variable, especially non-invasive blood pressure frequency (median 5, range 1-44 measurements). There was a high prevalence of hypothermia (73% of arrest survivors). There was substantial variability in laboratory frequency within 24 hours post-arrest. Patients with primary CPA received significantly more lab testing and had a higher prevalence of acidosis (pH < 7.2) than those with ARC-CPA. CONCLUSIONS We identified significant variation in post-arrest management and a high prevalence of hypothermia. These data highlight the need for post-arrest management guidelines specific to neonatal physiology, as well as opportunities for quality improvement initiatives. Further research is needed to ascertain the impact of neonatal post-arrest management on long-term outcomes and survival.
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Affiliation(s)
- Sarah A Coggins
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Mary Haggerty
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Heidi M Herrick
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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