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PubMed2005

Hypertonic resuscitation of hemorrhagic shock prevents alveolar macrophage activation by preventing systemic oxidative stress due to gut ischemia/reperfusion.

BACKGROUND: The gut is a target organ of shock/resuscitation (S/R); however, it also contributes to distant inflammation through the generation of oxidants. S/R with antioxidants such as N-acetylcysteine (NAC) prevents lipopolysaccharide (LPS)-induced cytokine production and NF-kappaB activation in rat alveolar macrophages. Therefore, we hypothesized that hypertonic saline (HTS) might exerts its protective effect by preventing gut ischemia/reperfusion injury, thus decreasing oxidative stress and distant priming in alveolar macrophages. METHODS: A two-hit rat model of shock resuscitation was used. Plasma levels of 8-iso-prostaglandin, a marker of lipid peroxidation, was quantified by eicosanoid immunoassay with acetylcholinesterase kit. Gut histology with hematoxylin and eosin staining was performed 1 to 6 hours after resuscitation. Alternatively, alveolar macrophages from bronchoalveolar lavage (BAL) at end resuscitation were incubated in vitro with LPS (0.01 mug/mL), and NF-kappaB translocation was observed by immunofluorescent staining with anti-p65 antibody. RESULTS: HTS resuscitation prevented leukosequestration in the alveolar space, and it abrogated the progressive rise in blood 8-iso-prostaglandin production observed with Ringer's lactate (RL) resuscitation. Inhibition of oxidant stress with NAC corresponded with the ability of HTS to prevent S/R-induced edema, villus flattening, and mucosal sloughing in the mid-ileum. LPS-induced NF-kappaB translocation in alveolar macrophages after RL was 42% compared to 20% after HTS. Similar attenuation was observed with NAC resuscitation (16%). CONCLUSIONS: HTS resuscitation prevents systemic oxidative stress by reducing gut ischemia/reperfusion injury and consequently attenuates distant alveolar macrophage priming, thereby reducing LPS-induced NF-kappaB nuclear translocation in alveolar macrophages and organ injury. This represents a novel mechanism whereby HTS exerts its immunomodulatory effects.

Animals↗

PubMed2005

Prehospital hemoglobin-based oxygen carrier resuscitation attenuates postinjury acute lung injury.

BACKGROUND: Crystalloid infusion has been the standard prehospital fluid resuscitation in the United States for the past 35 years, but the emergence of a safe and effective hemoglobin-based oxygen carrier (HBOC) may change that practice. The purpose of this in vivo study is to simulate an existing multicenter prehospital trial of HBOC versus crystalloid to determine the effects in a controlled 2-event construct of postinjury multiple organ failure. METHODS: Rats underwent hemorrhagic shock (30 mm Hg x 45 min) and were resuscitated over 2 hours in a clinically relevant design: 2 x volume of shed blood (SB) using normal saline (NS) in the first 30 minutes; 1/2 volume of SB in the next 30 minutes; another 2 x SB volume with NS over the remaining 60 minutes. Study groups represented alternative fluid strategies during the first hour of resuscitation: (1) Inhospital SB (standard resuscitation), (2) Inhospital HBOC, (3) Prehospital SB, and (4) Prehospital HBOC. Global physiologic response was assessed via tissue oxygenation (near infrared spectroscopy) and arterial base deficit, and pulmonary response, via lung polymorphonuclear neutrophil accumulation and vascular permeability. RESULTS: Prehospital HBOC resuscitation provided the most efficient recovery of tissue oxygenation and correction of base deficit, had the greatest reduction in pulmonary polymorphonuclear neutrophil accumulation, and abrogated acute lung injury. Prehospital SB and Inhospital HBOC regimens afforded intermediate lung protection, compared with standard resuscitation. CONCLUSIONS: The findings in this controlled in vivo study suggest prehospital HBOC resuscitation improves the recovery from postshock oxygen debt and reduces postinjury organ dysfunction.

Animals↗

PubMed2006

Hypertonic saline resuscitation improves intestinal microcirculation in a rat model of hemorrhagic shock.

BACKGROUND: Conventional resuscitation (CR) from hemorrhagic shock (HS) often restores and maintains hemodynamics but fails to restore intestinal perfusion. Post-CR intestinal ischemia has been implicated in the initiation of a gut-derived exaggerated systemic inflammatory response and in the progressive organ failure following HS. We propose that intestinal ischemia can be prevented with hypertonic saline resuscitation (HTSR). METHODS: Anesthetized male Sprague-Dawley rats (200 to 215 g) were hemorrhaged to 50% of mean arterial pressure (MAP) for 60 minutes and randomly assigned to 1 of the resuscitation groups (n = 7 each): Group I: sham operation and no HS; Group II: HS + CR with the return of the shed blood + 2 volumes of normal saline (NS); Group III: HS + return of the shed blood + hypertonic saline (HTS); (7.5 % NaCl, 4 ml/kg); Group IV: HS + HTS, then return of the shed blood after 60 minutes; Group V: HS + HTS, then 1 volume of NS after 60 minutes. Microvascular diameters of inflow (A1) and proximal and distal premucosal arterioles (A3) in terminal ileum and flow in A1 were measured using in vivo videomicroscopy and optical Doppler velocimetry. Hematocrit, plasma osmolarity, and electrolytes were measured in Groups II and III. RESULTS: HS caused a selective vasoconstriction in A1 arterioles that was not seen in the premucosal arterioles. CR restored and maintained MAP and caused generalized, progressive vasoconstriction at all intestinal arteriolar levels that is associated with hypoperfusion. HTSR failed to restore or maintain MAP or intestinal A1 arteriolar blood flow until the shed blood was returned. However, HTSR prevented the post-resuscitation, premucosal vasoconstriction and produced an insidious selective vasodilation in the A3 arterioles, which was most significant with early blood return (Group III). This selective arteriolar vasoactivity was associated with a significant improvement of endothelial cell function. Plasma hyperosmolality and hypernatremia persisted during the entire 2 hours post-resuscitation with HTS. CONCLUSIONS: Small-volume HTSR can be used as a resuscitation regimen at the trauma scene and for selective clinical conditions where hypotensive resuscitation is indicated. HTSR improves intestinal perfusion by selective vasodilation of the precapillary arterioles even at MAP close to shock levels.

Animals↗

PubMed2003

Trauma resuscitation time.

Documenting the timing and organisation of trauma resuscitation can be utilised to assess performance standards, and to ensure a high quality of trauma resuscitation procedures. Since there is no European literature available on trauma resuscitation time (TRT) in the emergency room, the aim of this descriptive study is to evaluate TRT in the Netherlands. The introduction of an ATLS-trained prehospital mobile medical team (MMT) in the Nijmegen area initiated the on-site advanced trauma life-support for the prehospital management of trauma patients. We studied TRT in two groups of patients, one with, the other without on-site care by a MMT. In the emergency room the use of videotape recording was chosen to document trauma resuscitation (22 actions) and TRT. A specially flow-chart was used to define the TRT-procedures. We studied 43 patients; 27 without MMT treatment and 16 with MMT treatment. The activities were divided into the ABCDE's of trauma care. Significant more patients of the MMT group were intubated before arrival in the hospital (12/16 (75%) versus 2/27 (2%), P<0.05). Eleven definitive airway management interventions (intubation) and one thoracic drainage in the non-MMT group were demanded by the protocol, but not performed before arrival in the hospital. Sixteen out of 22 actions that were documented were carried out at an earlier stage in the MMT group. There was no significant difference between the resuscitation times; in both groups the recorded median time was approximately 43 min. This prospective analysis demonstrates the timing of resuscitation procedures in a resuscitation room and provides some insight into the timing of ATLS initial assessment.

Adult↗

PubMedDate not supplied

Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis.

BACKGROUND: International consensus statements for resuscitation of newborn infants recommend provision of 100% oxygen with positive pressure if assisted ventilation is required. However, 100% oxygen exacerbates reperfusion injury in animals and reduces cerebral perfusion in newborn babies. We aimed to establish whether resuscitation with air decreased mortality or neurological disability in newborn infants compared with 100% oxygen. METHODS: We did a systematic review and meta-analysis of trials that compared resuscitation with air versus 100% oxygen, using the methods of the Cochrane Collaboration. We combined data for similar outcomes in the analysis where appropriate, using a fixed-effects model. FINDINGS: Five trials (two masked and three unmasked), consisting of 1302 newborn infants, fulfilled the inclusion criteria. Most babies were born at or near term in developing countries. In the three unmasked studies, infants resuscitated with room air who remained cyanotic and bradycardic were switched to 100% oxygen at 90 s. The masked studies allowed crossover to the other gas during the first minutes of life. Although no individual trial showed a difference in mortality, the pooled analysis showed a significant benefit for infants resuscitated with air (relative risk 0.71 [95% CI 0.54 to 0.94], risk difference -0.05 [-0.08 to -0.01]). The effect on long-term development could not be reliably determined because of methodological limitations in the one study that followed up infants beyond 12 months of age. INTERPRETATION: For term and near-term infants, we can reasonably conclude that air should be used initially, with oxygen as backup if initial resuscitation fails. The effect of intermediate concentrations of oxygen at resuscitation needs to be investigated. Future trials should include and stratify for premature infants.

Air↗

PubMed2000

Hypoglycemia and the ABC'S (sugar) of pediatric resuscitation.

STUDY OBJECTIVE: The purpose of this study was to determine the prevalence of hypoglycemia and describe the clinical variables associated with hypoglycemia in children receiving resuscitation care. METHODS: A cross-sectional study of consecutive children receiving resuscitation care in an emergency department was performed. Rapid glucose testing was prospectively established as one of the initial resuscitation steps, and clinical variables were obtained from a retrospective chart review. The setting was an urban children's hospital ED (Level II trauma center) with a census of 31, 000 per year and a 10% admission rate. The patient population consisted of children (birth to 20 years of age) receiving resuscitation care for altered consciousness, status epilepticus, respiratory failure, cardiac failure, and cardiopulmonary arrest. RESULTS: Over a 1-year period, 49 nontrauma-related children received resuscitation care. Nine (18%; 95% confidence interval 8.7 to 32.2) were hypoglycemic (glucose level </=40 mg/dL). The median time from ED presentation to rapid glucose testing was 11 minutes (range, 0 to 65 minutes). Four of the hypoglycemic children had septic shock. The mortality rate was significantly greater (P =.015) in the hypoglycemic children. CONCLUSION: Because hypoglycemia occurs often in children requiring resuscitation and clinical signs are often unspecific, routine rapid assessment of serum glucose is recommended. To increase physician awareness, adding "S" (sugar) to the popular mnemonic A (airway), B (breathing), and C (circulation): ABC'S is recommended. [Losek JD. Hypoglycemia and the ABC'S (sugar) of pediatric resuscitation. Ann Emerg Med. January 2000;35:43-46.]

Abbreviations as Topic↗

PubMed1992

Health care worker exposure to HIV-1 and HTLV I-II in critically ill, resuscitated emergency department patients.

STUDY OBJECTIVE: Exposure to HIV-1 is of profound concern to health care workers. HTLV-I and HTLV-II, retroviruses with similar modes of transmission as HIV-1, also cause disease in human beings. Emergency department resuscitations are high-risk situations for such exposure. The purpose was to determine the seroprevalence of HIV-1 and HTLV I-II in patients undergoing ED resuscitations, the magnitude of health care worker exposure, and risk factors associated with infection. DESIGN: Prospective identity-unlinked seroepidemiologic study. SETTING: ED of a 950-bed private inner-city teaching hospital. Participants included 370 patients undergoing ED resuscitations. MEASUREMENTS: Serum was tested for antibodies to HIV-1 and HTLV I-II. Questionnaires were completed by the physician in charge of the ED resuscitations. RESULTS: Fifteen (4.1%) (95% confidence interval [CI], 2.1% to 6.1%) patients were HIV-1 seropositive, and seven (1.9%) (95% CI, 0.7% to 3.1%) were HTLV I-II positive. Eleven (5.6%) (95% CI, 2.4% to 8.8%) of 197 trauma patients and 11 (6.4%) (95% CI, 2.8% to 10.0%) of 173 medical patients were infected with one of these viruses. Health care workers had direct cutaneous contact with patient blood during 114 (31%) ED resuscitations and with infected patient blood during 11 (3%) ED resuscitations. An additional 11 ED resuscitations involved parenteral exposures, one to HIV-1-infected blood. No factors could be identified that would quickly and reliably predict infection. CONCLUSION: Health care workers must protect themselves in such high-risk situations by strict compliance to mandatory universal precautions.

Adolescent↗

PubMed1986

Effect of nifedipine on cerebral high-energy phosphates after cardiac arrest and resuscitation in the rat.

We studied the effect of nifedipine, a calcium entry blocker, on the recovery of cerebral adenosine triphosphate (ATP), creatine phosphate (CP), and lactate levels following resuscitation from cardiac arrest. Using the cardiac arrest and resuscitation model of de Garavilla, Babbs, and Tacker with an arrest time of eight minutes, 76% of the animals arrested were resuscitated with an average intermittent abdominal compression-CPR time of 3.3 minutes. Rats were assigned randomly to the following groups: nonischemic; eight minutes of arrest without resuscitation; and postresuscitation treatment with either IV normal saline; 3 micrograms/kg nifedipine; 10 micrograms/kg nifedipine; or 30 micrograms/kg nifedipine. Treated animals were sacrificed at either 20 or 120 minutes thereafter. As expected, after eight minutes of cardiac arrest, the levels of ATP and CP dropped to near 0 and rebounded in all resuscitated animals. By 120 minutes after resuscitation, rats given the 10-micrograms/kg dose of nifedipine had levels of ATP equivalent to nonischemic values. Return of CP values to nonischemic levels was seen only at the 3-micrograms/kg dose and was independent of time of measurement. The ATP and CP levels in these nifedipine-treated groups were significantly better when compared to saline-treated controls. There were no treatment-dependent differences in lactate levels. We conclude that clinically appropriate doses of nifedipine had a beneficial effect on the recovery of cerebral high-energy phosphates after cardiac arrest and resuscitation.

Adenosine Triphosphate↗

PubMed2000

Resuscitation in shock associated with burns. Tradition or evidence-based medicine?

OBJECTIVE: To summarize the present standards and guidelines for fluid treatment of shock associated with burns, and to evaluate their scientific support in the literature. DESIGN: Nonsystematic, critical review of the literature regarding the indications for crystalloid and colloid fluid treatment, invasive monitoring and the use of resuscitation end points in shock associated with burns. SUMMARY POINTS: Crystalloid fluid resuscitation of patients with burns is traditionally managed using empirical resuscitation formulae, with the efficacy monitored by vital signs and urinary output The value of these end points has been questioned by recent studies, which have suggested that such noninvasive parameters may be inadequate for detecting malperfusion. No consensus exists regarding appropriate assessment of adequate resuscitation, and the impact on survival of invasive measures has still to be proven in controlled randomized trials. Generally, a significantly higher fluid requirement has been demonstrated when resuscitation is based on invasive cardiorespiratory monitoring. Colloid resuscitation in burns patients is controversial. Published reports suggest that colloid infusion should be started between 6 and 36 h following thermal injury. A recent meta-analysis highlighted the shortcomings of albumin in patients with burns, and this, together with restrictions for the use of plasma products, has obscured the choice of colloid solution. The effect of colloid resuscitation on survival remains to be proven in burned patients. CONCLUSION: The current standards for monitoring fluid therapy in patients with large burns are not supported by scientific data. Further randomized, controlled trials are indicated, and should help establish general guidelines regarding monitoring and treatment end points in these patients.

Clinical Medicine↗

PubMed2001

Evaluation of a hospital-wide resuscitation team: does it increase survival for in-hospital cardiopulmonary arrest?

OBJECTIVE: To assess the impact (defined not only with regard to patient outcome but also to record keeping for evaluation of care) of a formal, structured resuscitation team for in-hospital cardiopulmonary resuscitation over the year following its creation. METHODS: This is a "before and after" study in which charts of all patients needing resuscitation during the two-year period were reviewed and data arranged in the Utstein Style of in-hospital reporting of cardiac arrests. The review was limited to adults (> or = 18 years of age) in nonICU settings. RESULTS: A total of 220 events were identified. Demographics and presenting rhythms for the two periods under review were similar. For the period of August 1996-August 1997 (group 1), there were 70 resuscitation events recorded with a return of spontaneous circulation (ROSC) rate of 21/70 (30%). For the period of August 1997-August 1998 (group 2), 150 events were recorded and the ROSC rate was significantly higher 87/150 (58%)) (P=0.0002). ROSC after ventricular fibrillation and ventricular tachycardia was similar in both groups (50 vs 57%) (P = 1.00) but an improvement in survival was seen in group 2 from events of bradycardia perfusing rhythm (25% vs 84%) (P = 0.0003). Survival from PEA/Asystole was also improved during period 2 (18 vs 48%) (P = 0.013). Survival to discharge was seen in 3/50 (6%) of patients in period 1 and 18/102 (18%) of patients in period 2 (P = 0.09). CONCLUSIONS: The formation of a structured, formalized hospital resuscitation team was associated with an increase in the number of recorded events, in the number of patients experiencing ROSC and in the percentage of patients who were discharged from the hospital. Facilities with no formal resuscitation team or with no skilled, practiced resuscitator on their current team should consider implementation of a similar strategy.

Adult↗

PubMed1997

Paediatric life support. An advisory statement by the Paediatric Life Support Working Group of the International Liaison Committee on Resuscitation.

This document reflects the deliberations of ILCOR. The epidemiology and outcome of paediatric cardiopulmonary arrest and the priorities, techniques and sequence of paediatric resuscitation assessments and interventions differ from those of adults. The working group identified areas of conflict and controversy in current paediatric basic and advanced life support guidelines, outlined solutions considered and made recommendations by consensus. The working group was surprised by the degree of conformity already existing in current guidelines advocated by the American Heart Association (AHA), the Heart and Stroke Foundation of Canada (HSFC), the European Resuscitation Council (ERC), the Australian Resuscitation Council (ARC), and the Resuscitation Council of Southern Africa (RCSA). Differences are currently based upon local and regional preferences, training networks and customs, rather than scientific controversy. Unresolved issues with potential for future universal application are highlighted. This document does not include a complete list of guidelines for which there is no perceived controversy and the algorithm/decision tree figures presented attempt to follow a common flow of assessments and interventions, in coordination with their adult counterparts. Survival following paediatric prehospital cardiopulmonary arrest occurs in only approximately 3-17% and survivors are often neurologically devastated. Most paediatric resuscitation reports have been retrospective in design and plagued with inconsistent resuscitation definitions and patient inclusion criteria. Careful and thoughtful application of uniform guidelines for reporting outcomes of advanced life support interventions using large, randomized, multicenter and multinational clinical trials are clearly needed. Paediatric advisory statements from ILCOR will, by necessity, be vibrant and evolving guidelines fostered by national and international organizations intent on improving the outcome of resuscitation for infants and children worldwide.

Adolescent↗

PubMed1999

Resuscitation of drowning victims in south-east Scotland.

INTRODUCTION: Immersion in cold water is compatible with long-term survival, even when the period of immersion is relatively long. Guidelines for resuscitation after immersion stress the importance of prolonged resuscitation using advanced life support techniques. METHODS: Deaths due to drowning in south-east Scotland between 1991 and 1997 were reviewed, using a variety of data sources. RESULTS: 95 deaths (69 males, 26 females) from drowning occurred in the following sites: sea, 35; bath, 15; flowing freshwater, 26; still freshwater, 19; 22 (23%) of the drowning incidents were witnessed, 73 (77%) were unwitnessed. 28 individuals were recovered within 1 h of being seen alive, 13 having had witnessed accidents, 15 having had unwitnessed accidents. Six individuals were not resuscitated at the scene by the emergency services, despite being last seen alive within the previous hour. A further five individuals were initially resuscitated, but declared dead at the scene within 1 h of being known to be alive. CONCLUSIONS: Members of the emergency services, are failing to both initiate prehospital resuscitation and to continue this to hospital for victims of near drowning. There appears to be potential to reduce the drowning death rate by improving resuscitation. The emergency services and the public should be educated about the need to resuscitate those found in water.

Adolescent↗

PubMed1999

Leadership of resuscitation teams: "Lighthouse Leadership'.

AIM: The purpose of this study was to determine the relationship between leadership behaviour, team dynamics and task performance. METHODS: This was as an observational study, using video recordings of 20 resuscitation attempts. The Leadership Behaviour Description Questionnaire (LBDQ) was used to measure the level of structure built within the team. Interpersonal behaviour and the tasks of resuscitation were measured with a team dynamics and a task performance scale. The degree to which the leader actively participated, 'hands on', with the tasks of resuscitation, and their previous training in advanced life support (ALS), and experience of resuscitation attempts, were evaluated against the leadership rating. RESULTS: The degree to which the leader built a structure within the team was found to correlate significantly with the team dynamics (P = 0.000) and the task performance (P = 0.013). Where the leaders participated 'hands on' they were less likely to build a structured team (P = 0.005), the team were less dynamic (P = 0.028) and the tasks of resuscitation were performed less effectively (P = 0.099). Experience gained over a 1-year period did not enhance leadership performance, but leaders who had up to 3 years experience were more likely to be effective in this role (P = 0.072). Interestingly, ALS training did not enhance leadership performance per se. However those leaders who had had recent ALS training were more likely not to participate 'hands on' (P = 0.035). There were some notable shortcomings in the performance of the task and some interesting correlations relating to duration of resuscitation, survival rate estimations, the leaders' attitudes and the teams' level of experience. CONCLUSION: Leaders must build a structure within a resuscitation team in order for them to perform effectively. An emergency leadership training programme is essential to enhance the performance of leaders and their teams.

Cardiopulmonary Resuscitation↗

PubMed2000

Witnessed resuscitation by relatives.

Witnessed resuscitation is the process of active 'medical' resuscitation in the presence of family members. Witnessed resuscitation though not as yet wide spread in practice is becoming established. Early reports of programs designed to promote such a process first appeared in the early 1980s. More recent work appears to show both public support and a desire for inclusion in the resuscitation process. Some research has been produced that indicates both satisfaction and psychological benefit for those relatives enabled to witness. Limited work only, exists pertaining to the effects on health care providers and these reports currently do not show any significant deleterious effects. Approval of witnessed resuscitation programs is not universal amongst all groups of health care workers. Concerns about the ethics of witnessed resuscitation and its medico-legal implications have been raised. The quality of the initial witnessed resuscitation reports is however variable and there is a great need for further work to validate the initial findings particularly in the areas of psychological stressors in staff and risk management implications.

Attitude of Health Personnel↗

PubMed1984

Cimetidine kinetics during resuscitation from burn shock.

Severely burned patients suffer from rapidly changing metabolic and hemodynamic abnormalities that could alter drug kinetics. The kinetics of cimetidine, commonly used in the prophylaxis of acute stress erosions, were studied during fluid resuscitation of 11 patients with mean burn sizes of 45% total body surface area. Six patients were studied after the completion of fluid resuscitation. Total clearance, steady-state volume of distribution, and cimetidine t1/2 did not change between the early period after burn and after fluid resuscitation, but before the completion of fluid resuscitation patients had lower renal and greater nonrenal cimetidine clearance than after resuscitation. The increase in nonrenal cimetidine clearance resulted in decreased urinary recovery of unchanged drug, 50.7 +/- 14% during fluid resuscitation and 81.0% +/- 6% after resuscitation.

Adult↗

PubMed2000

Relationship between fetal monitoring and resuscitative needs: fetal distress versus routine cesarean deliveries.

BACKGROUND: There is debate as to whether pediatricians should be present at all cesarean deliveries. Little published data exist regarding the differences in resuscitative needs of infants delivered by cesarean section for "fetal distress" versus those without this diagnosis. OBJECTIVE: To describe the differences in resuscitative and immediate postnatal intervention needs for neonates with fetal distress delivered by cesarean section and those without fetal distress delivered in the same manner. Also, to devise an evaluation tool to assess and compare levels of neonatal resuscitation between infants and groups of infants. METHODS: The delivery records of 1411 term infants delivered by cesarean section after uncomplicated pregnancies at Los Angeles County/University of Southern California Medical Center from March 3, 1995 through March 8, 1997 were examined retrospectively. Apgar scores and resuscitative needs were assigned to a newly devised, weighted scoring system. Resuscitation subscores and total resuscitation scores were compared using non-parametric methods. RESULTS: The fetal distress group (n = 80) had a significantly greater resuscitative needs mean score (p < 0.001) and subscores (p < 0.001 to p = 0.004) than did the non-fetal distress group (n = 419). Of the non-fetal distress group, 48.7% still received some active form of intervention. CONCLUSION: In our study group, infants with fetal distress had significantly greater intervention needs than infants without fetal distress.

Cesarean Section↗

PubMedDate not supplied

Delivery room resuscitation decisions for extremely low birthweight infants in California.

OBJECTIVE: To characterize physician-parent counseling and delivery room resuscitation of extremely low birthweight (ELBW) infants. STUDY DESIGN: Cross-sectional survey of 473 California neonatologists detailing counseling patterns, resuscitation thresholds, and acceptance of parental decision making. RESULTS: The response rate was 61%. After 23 weeks' gestation, > 80% of neonatologists counseled parents expecting ELBW infants. All (> 99%) counseled parents about mortality; > 25% reported not discussing limiting resuscitation or death despite resuscitation. Decisions to limit resuscitation were affected by congenital anomalies, parents' wishes, or perceptions of pain, suffering, and quality of life. Nearly 70% of neonatologists supported parental decision making at 22 to 23 weeks, whereas 66% to 74% responded that parents should not be allowed to make nonresuscitation decisions after 26 weeks. Median resuscitation thresholds were 23 weeks (range 20-28) and 500 g (range 350-1000). CONCLUSIONS: Neonatologists' failure to discuss nonresuscitation options, variations in resuscitation thresholds, and unwillingness to accept nonresuscitation decisions for more mature ELBW infants may restrict parental decision making.

Adult↗

PubMed2001

Evaluation of the effectiveness of the standardized neonatal resuscitation program.

OBJECTIVE: To determine if health care personnel trained in the Neonatal Resuscitation Program (NRP) used the NRP guidelines in the resuscitation of newborn babies. To determine differences between self-reporting and documentation of resuscitation in medical records. STUDY DESIGN: Using a validated questionnaire, individuals participating in resuscitation of newborns voluntarily phoned and answered questions on an Interactive Voice Response (IVR) system. The study was undertaken in level II hospitals in Southern Alberta with 7500 deliveries per year. RESULTS: Of the 5155 babies delivered during the study, 16% required resuscitation (bag and mask ventilation 10.6%, intubation for meconium or intermittent positive pressure ventilation, IPPV, 3.6%, cardiac massage, CM, 0.3%, epinephrine 0.1%, naloxone 6.9%). Of babies whose interventions could be assessed, bag and mask was correct in 99%, endotracheal intubation for IPPV in 100%, and CM in 100%. Only 75% of babies had meconium managed correctly and 92% had naloxone administered according to guidelines. There were more instances where IVR (48) reported a procedure, which was not charted versus charted and not reported by IVR (21). Educational needs identified by IVR included skills of resuscitation and NRP indications for management. CONCLUSION: Bag and mask ventilation and intubation for neonatal resuscitation are more common than previously reported. Management of the meconium-stained baby and use of naloxone require further education. Compared to charts, use of IVR system allows more complete documentation with rationale of interventions and identification of continuing educational needs.

Guideline Adherence↗