Neonatal resuscitation

Three decades of ongoing research and obstetric and pediatric education have seen neonatal resuscitation develop into a well-organized delivery room procedure. Because neonatal resuscitation does not occur frequently in the Emergency Department, few are well prepared. A designated site in the Emergency Department, trained personnel, appropriate equipment and well defined procedures are necessary. These recommendations for the organization of the resuscitation site, procedures, therapeutic drugs, and required equipment must be individualized to each Emergency Department.     

Neonatal resuscitation

The long-term outcome of infants subjected to perinatal asphyxia can be improved if they are recognized as high risk before birth and managed so as to reduce the period of hypoxemia to a minimum. Prompt and effective resuscitation of asphyxiated infants at the time of birth can contribute much to improving the long-term outcome of these infants.     

Neonatal resuscitation

Ten million or more newborns worldwide each year need some type of resuscitation assistance. More than 1 million babies die annually from complications of birth asphyxia. Over the past 3 decades, neonatal resuscitation has evolved from disparate, word-of-mouth teaching methods to organized programs. The most widely-used curriculum is the Neonatal Resuscitation Program, which is supported by the American Academy of Pediatrics and the American Heart Association. To date more than 1.5 million individuals have been trained in the Neonatal Resuscitation Program. Resuscitation efforts are geared toward avoiding or mitigating the adverse sequelae of asphyxia neonatorum. Certain characteristics distinguish the preterm infant, including propensity to become hypothermic and higher potential for adverse neurologic and pulmonary complications from resuscitation efforts. In this era of evidence-based medicine the most recent Neonatal Resuscitation Program guidelines were developed to provide recommendations based on the best currently-available science. A number of major proposals received considerable scrutiny during the evaluation process. Many areas of neonatal resuscitation still need to be studied.     

Neonatal resuscitation: an update

Appropriate resuscitation must be available for each of the more than 4 million infants born annually in the United States. Ninety percent of infants transition safely, and it is up to the physician to assess risk factors, identify the nearly 10 percent of infants who need resuscitation, and respond appropriately. A team or persons trained in neonatal resuscitation should be promptly available to provide resuscitation. The Neonatal Resuscitation Program, which was initiated in 1987 to identify infants at risk of needing resuscitation and provide high-quality resuscitation, underwent major updates in 2006 and 2010. Among the most important changes are to not intervene with endotracheal suctioning in vigorous infants born through meconium-stained amniotic fluid (although endotracheal suctioning may be appropriate in nonvigorous infants); to provide positive pressure ventilation with one of three devices when necessary; to begin resuscitation of term infants using room air or blended oxygen; and to have a pulse oximeter readily available in the delivery room. The updated guidelines also provide indications for chest compressions and for the use of intravenous epinephrine, which is the preferred route of administration, and recommend not to use sodium bicarbonate or naloxone during resuscitation. Other recommendations include confirming endotracheal tube placement using an exhaled carbon dioxide detector; using less than 100 percent oxygen and adequate thermal support to resuscitate preterm infants; and using therapeutic hypothermia for infants born at 36 weeks' gestation or later with moderate to severe hypoxic-ischemic encephalopathy.     

Neonatal resuscitation.

A variety of common situations result in asphyxia of the newborn. The infant may be born in secondary or terminal asphyxia. The infant at greatest risk of neurologic sequelae is the low birth weight infant with a low five-minute Apgar score. Personnel must be trained and the delivery room must be properly equipped for successful resuscitation. For example, a radiant warmer is essential. Meconiumstained infants require special care. Meconium must be removed from the airway. The list of postasphyxial complications is formidable.     

Attitudes toward the performance of bystander cardiopulmonary resuscitation in Japan

BACKGROUND: Early initiation of bystander cardiopulmonary resuscitation (CPR) improves the chances of successful resuscitation and survival. The importance of bystander CPR is attracting more interest, and there has been an increase in attendance at CPR training courses in Japan. However, there have been few reports regarding Japanese attitudes toward the performance of bystander CPR. The present study was performed to identify current Japanese attitudes toward bystander CPR compared to our previous study performed in 1998. METHODS AND RESULTS: Between February and March 2006, participants were asked about their willingness to perform CPR in five varying scenarios, i.e., performing CPR on a stranger, a trauma patient, a child, an elderly person, and a relative, and CPR techniques consisting of chest compression plus mouth-to-mouth ventilation (CC plus MMV) versus chest compression only (CC only). A total of 4223 individuals (male 50%) completed the questionnaire, including high school students, teachers, emergency medical technicians (EMTs), medical nurses, and medical students. About 70% of the subjects had experienced CPR training more than once. Only 10-30% of high school students, teachers, and health care providers reported willingness to perform CC plus MMV, especially on a stranger or trauma victim. In contrast, 70-100% of these subjects reported willingness to perform CC only, which was the same as in our previous study. The reasons for the unwillingness among laypeople to perform CC plus MMV were inadequate knowledge and/or doubt regarding whether they could perform the techniques effectively, while health care providers reported a fear contracting of a disease. CONCLUSIONS: Most laypeople and health care providers are unlikely to perform CC plus MMV, especially on a stranger or trauma victim, but are more likely to perform CC only, as also found in our previous study in 1998. These findings suggest that MMV training should be de-emphasised and the awareness of CC alone should be emphasised because, for whatever reason, people do not want to perform MMV.     

Neonatal resuscitation: in pursuit of evidence gaps in knowledge

Guidelines for the techniques of resuscitating newly born infants have undergone major revisions over the past 25 years. The International Liaison Committee on Resuscitation (ILCOR) is committed to "periodically developing and publishing a consensus on resuscitation science" every five years with the most recent Consensus on Science and Treatment Recommendations (CoSTR) statement published in 2010. The CoSTR document is used as a basis for developing specific resuscitation guidelines felt to be appropriate for implementation in respective countries. A "gaps in knowledge" summary is created at the conclusion of a cycle. It is a goal that identification of these knowledge gaps will stimulate investigators to pursue more targeted studies to help close the gaps. The current document is based on the "gaps in knowledge" summary for neonatal resuscitation that was created at the conclusion of the 2005-2010 ILCOR cycle.     

Comparison of ventilation performance: standard resuscitation bag and the resuscitation bag controller

Clinical evaluation of ventilation performance during resuscitation is largely subjective. A mechanical device, the resuscitation bag controller (RC), which encircles the bag and allows controlled compression may improve the precision and accuracy of ventilation with manual resuscitation bags (MRB). We hypothesize that more precise, controlled pressure ventilation can be delivered with the RC, compared to the MRB. Prehospital (N = 13) and hospital personnel (N = 12) who routinely perform manual ventilation were randomized to either method of ventilation. Operators were instructed to ventilate an intubated adult mannequin. The percent of breaths delivered within a specified range, 800 to 1200 mL, was compared using simple regression analysis. The precision of tidal volume (TV) and peak airway pressure (PAP) was compared between methods and groups using the coefficient of variation. Comparison for significant differences between methods and groups in the number of breaths with a TV less than 800 mL and those with pressures greater than 30 cm H20 was performed using chi square or Fisher's exact test. There were no significant differences in the percent of acceptable breaths or mean TV delivered between methods or groups. The precision (i.e., reproducibility of the same value) of TV for both methods was best for hospital personnel. PAPS were less than or equal to 30 cm H2O for 93% of all breaths. Hospital personnel delivered a significantly greater percent of inadequate (less than 0.8 L) breaths, 19 versus 7.4%, and excessive pressure breaths, 9.2 versus 4.2%, when compared to prehospital personnel. We conclude that the resuscitation bag controller offers little advantage over standard bag resuscitation for adult resuscitation.(ABSTRACT TRUNCATED AT 250 WORDS)     

社区人群心肺复苏术认知情况调查

[目的]了解社区人群对徒手心肺复苏术（CPR）知识的认知情况,为广泛开展CPR培训提供参考。[方法]采用自行设计的问卷调查表对武汉市社区人群16 946人进行CPR认知情况调查。[结果]社区人群对CPR认知度低,只有22.88%知道或听说过,会CPR操作者574人,占3.39%。[结论]社区人群缺乏CPR知识,建议对全民进行CPR知识普及和技能培训,从而提高心脏骤停病人抢救成功率,保障人民生命安全。     

社区人群心肺复苏术认知情况调查

[目的]了解社区人群对徒手心肺复苏术(CPR)知识的认知情况,为广泛开展CPR培训提供参考。[方法]采用自行设计的问卷调查表对武汉市社区人群16 946人进行CPR认知情况调查。[结果]社区人群对CPR认知度低,只有22.88%知道或听说过,会CPR操作者574人,占3.39%。[结论]社区人群缺乏CPR知识,建议对全民进行CPR知识普及和技能培训,从而提高心脏骤停病人抢救成功率,保障人民生命安全。     

The ethical attitude of emergency physicians toward resuscitation in Korea

This study was conducted to assess the various ethical attitudes of emergency specialists in Korea toward resuscitation. A questionnaire investigating the following key topics concerning the ethics of resuscitation was sent to emergency specialists in Korea: when not to attempt resuscitation, when to stop resuscitation, withdrawal of life-sustaining treatment, diagnosis of death by non-physicians, permission for family members to stay with the patient during resuscitation, and teaching with the body of the recently deceased patient. We found broad variation in medical practice at patient death and in the ethical considerations held and followed by emergency physicians (EPs) during resuscitation in Korea. Initiating and concluding resuscitation attempts were practiced according to ethical and cultural norms, as well as medical conditions. Guidelines for resuscitation ethics that are based on the Korean medico-legal background need to be developed. Education of EPs to solve the ethical dilemma in resuscitation is needed.     

The attitudes of Japanese high school students toward cardiopulmonary resuscitation

BACKGROUND AND OBJECTIVES: It is essential to have a clear understanding of the present condition of cardiopulmonary resuscitation (CPR) training courses and the associated problems. The present study was performed to identify the current conditions of CPR training in Japanese high schools and the attitudes of students toward CPR. METHODS AND RESULTS: We distributed a questionnaire study to the students of 12 cooperating high schools regarding their willingness to perform CPR in 5 hypothetical scenarios of cardiopulmonary arrest: a stranger, a trauma patient, a child, an elderly person, and a relative. Between February and March 2006, a total of 3316 questionnaires were completed. Across all scenarios, only 27% of respondents from general high schools reported willingness to perform chest compression (CC) plus mouth-to-mouth ventilation (MMV), and 31% reported willingness to perform CC alone. Fifty-nine percent of students had previous CPR training, and only 35% were willing to perform CC plus MMV. Most of the respondents who reported that they would decline to perform full CPR, stated that poor knowledge and/or fear of incomplete performance of CPR were deciding factors. CONCLUSIONS: Japanese high school students are reluctant to perform CC plus MMV, despite having received training. The present educational system in Japan has limitations in encouraging high school students to perform CC plus MMV.     

对驾驶人员心肺复苏知识水平调查分析

根据2006年11月由中华人民共和国交通部颁布的<道路运输从业人员管理规定>的要求,从事道路危险品运输、道路客车运输、机动车培训教练及危险货物运输的驾驶人员应掌握交通急救技术,包括心肺复苏技能.心肺复苏术是所有急救技术中最基本的救命技术,只要按照规范化的要求去做就可能猝死病人起死回生[1].为选择最好的培训方法,使驾驶人员能在较短的时间内掌握心肺复苏技能,学院医务人员对将参加培训的驾驶人员进行问卷调查,现报告如下.