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Objectives: To describe the frequency of neonatal resuscitation interventions implemented for newborn babies in the state of Queensland over a 10-year period and determine if these changes suggest adherence to changes in Australian guidelines.Study Design: A population-based retrospective cohort study utilising the Queensland Perinatal Data Collection dataset. All liveborn babies ≥23 + 0 weeks + days gestation born between 1 July 2007 and 30 June 2017 were included except those for whom resuscitation was not attempted and those babies <25 + 0 weeks for whom it was unsuccessful. Trends in resuscitation were demonstrated using Loess regression.Results: Of 618,589 eligible newborns,182,260 received any resuscitation manoeuvre (29.5%). The proportion receiving oxygen without assisted ventilation declined from 19.3% in 2007-08 to 5.6% in 2016-17. Upper airway suctioning also decreased. Assisted ventilation increased from 7.9% to 10.0% of all babies with the largest contribution from late preterm and term babies. The rate of endotracheal suctioning for meconium and the rate of narcotic antagonist use also declined. A greater proportion of babies received chest compressions (1.9-3.2 per 1000 babies) and adrenaline (epinephrine). Mortality decreased from 1.9 to 1.5 per 1000 babies in the cohort.Conclusion: Ten-year trends showed reduced use of oxygen or upper airway suctioning without assisted ventilation, reduced intubation to suction meconium, reduced use of narcotic antagonists and greater use of assisted ventilation suggesting appropriate practice change in response to Australian neonatal resuscitation guidelines. The increase in the use of chest compressions and adrenaline was unexpected and the reasons for it are unclear. [ABSTRACT FROM AUTHOR]

Summary: Aim of the study: Endotracheal intubation is the preferred method to ensure proper artificial ventilation. Early detection of esophageal intubation is important for an individual patient''s outcome. The aim of the study was to see if impedance measurements can be used to detect esophageal intubation, using the impedance measurement system of an experimental defibrillator. Materials and methods: Patients who died at the emergency department of a tertiary care hospital were eligible to be studied. After death was declared, patients were ventilated with a predefined tidal volume alternately via the conventional tracheal tube and via an additionally tube placed into the esophagus. The lowest and respectively highest median impedance amplitude for the first three ventilations was used as cut-off to calculate predictive values. Results: We enrolled 10 patients (mean age 65 years (S.D. 14), 7 male) of whom 9 underwent CPR prior to death, 30% of the patients had a BMI>30. Severe lung-edema was present in 2 cases. The lowest tracheal impedance value was 0.736Ω and the highest esophageal was 0.496Ω. A ROC curve for this individualised approach gave an area under the curve of 1 (95% CI 0.001, 0.249). Conclusion: There is a large and significant reduction in transthoracic impedance when the tube is malpositioned in the esophagus. It may therefore be feasible to detect malintubation via thoracic impedance changes as an aid to improve the survival of critical ill patients. Further investigations on a larger population are needed. [Copyright &y& Elsevier]