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1. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations: Summary from the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; And First Aid Task Forces

Author

Wyckoff, M. H., Greif, R., Morley, P. T., Ng, K. -C., Olasveengen, T. M., Singletary, E. M., Soar, J., Cheng, A., Drennan, I. R., Liley, H. G., Scholefield, B. R., Smyth, M. A., Welsford, M., Zideman, D. A., Acworth, J., Aickin, R., Andersen, L. W., Atkins, D., Berry, D. C., Bhanji, F., Bierens, J., Borra, V., Bottiger, B. W., Bradley, R. N., Bray, J. E., Breckwoldt, J., Callaway, C. W., Carlson, J. N., Cassan, P., Castren, M., Chang, W. -T., Charlton, N. P., Chung, S. P., Considine, J., Costa-Nobre, D. T., Couper, K., Couto, T. B., Dainty, K. N., Davis, P. G., De Almeida, M. F., De Caen, A. R., Deakin, C. D., Djarv, T., Donnino, M. W., Douma, M. J., Duff, J. P., Dunne, C. L., Eastwood, K., El-Naggar, W., Fabres, J. G., Fawke, J., Finn, J., Foglia, E. E., Folke, F., Gilfoyle, E., Goolsby, C. A., Granfeldt, A., Guerguerian, A. -M., Guinsburg, R., Hirsch, K. G., Holmberg, M. J., Hosono, S., Hsieh, M. -J., Hsu, C. H., Ikeyama, T., Isayama, T., Johnson, N. J., Kapadia, V. S., Kawakami, M. D., Kim, H. -S., Kleinman, M., Kloeck, D. A., Kudenchuk, P. J., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lee, H. C., Lin, Y. (., Lockey, A. S., Maconochie, I. K., Madar, R. J., Malta Hansen, C., Masterson, S., Matsuyama, T., Mckinlay, C. J. D., Meyran, D., Morgan, P., Morrison, L. J., Nadkarni, V., Nakwa, F. L., Nation, K. J., Nehme, Z., Nemeth, M., Neumar, R. W., Nicholson, T., Nikolaou, N., Nishiyama, C., Norii, T., Nuthall, G. A., O'Neill, B. J., Ong, Y. -K. G., Orkin, A. M., Paiva, E. F., Parr, M. J., Patocka, C., Pellegrino, J. L., Perkins, G. D., Perlman, J. M., Rabi, Y., Reis, A. G., Reynolds, J. C., Ristagno, G., Rodriguez-Nunez, A., Roehr, C. C., Rudiger, M., Sakamoto, T., Sandroni, Claudio, Sawyer, T. L., Schexnayder, S. M., Schmolzer, G. M., Schnaubelt, S., Semeraro, F., Skrifvars, M. B., Smith, C. M., Sugiura, T., Tijssen, J. A., Trevisanuto, D., Van De Voorde, P., Wang, T. -L., Weiner, G. M., Wyllie, J. P., Yang, C. -W., Yeung, J., Nolan, J. P., Berg, K. M., Burdick, M. C., Cartledge, S., Dawson, J. A., Elgohary, M. M., Ersdal, H. L., Finan, E., Flaatten, H. I., Flores, G. E., Fuerch, J., Garg, R., Gately, C., Goh, M., Halamek, L. P., Handley, A. J., Hatanaka, T., Hoover, A., Issa, M., Johnson, S., Kamlin, C. O., Ko, Y. -C., Kule, A., Leone, T. A., Mackenzie, E., Macneil, F., Montgomery, W., O'Dochartaigh, D., Ohshimo, S., Palazzo, F. S., Picard, C., Quek, B. H., Raitt, J., Ramaswamy, V. V., Scapigliati, Andrea, Shah, B. A., Stewart, C., Strand, M. L., Szyld, E., Thio, M., Topjian, A. A., Udaeta, E., Vaillancourt, C., Wetsch, W. A., Wigginton, J., Yamada, N. K., Yao, S., Zace, D., Zelop, C. M., Sandroni C. (ORCID:0000-0002-8878-2611), Scapigliati A. (ORCID:0000-0002-4044-2343), Wyckoff, M. H., Greif, R., Morley, P. T., Ng, K. -C., Olasveengen, T. M., Singletary, E. M., Soar, J., Cheng, A., Drennan, I. R., Liley, H. G., Scholefield, B. R., Smyth, M. A., Welsford, M., Zideman, D. A., Acworth, J., Aickin, R., Andersen, L. W., Atkins, D., Berry, D. C., Bhanji, F., Bierens, J., Borra, V., Bottiger, B. W., Bradley, R. N., Bray, J. E., Breckwoldt, J., Callaway, C. W., Carlson, J. N., Cassan, P., Castren, M., Chang, W. -T., Charlton, N. P., Chung, S. P., Considine, J., Costa-Nobre, D. T., Couper, K., Couto, T. B., Dainty, K. N., Davis, P. G., De Almeida, M. F., De Caen, A. R., Deakin, C. D., Djarv, T., Donnino, M. W., Douma, M. J., Duff, J. P., Dunne, C. L., Eastwood, K., El-Naggar, W., Fabres, J. G., Fawke, J., Finn, J., Foglia, E. E., Folke, F., Gilfoyle, E., Goolsby, C. A., Granfeldt, A., Guerguerian, A. -M., Guinsburg, R., Hirsch, K. G., Holmberg, M. J., Hosono, S., Hsieh, M. -J., Hsu, C. H., Ikeyama, T., Isayama, T., Johnson, N. J., Kapadia, V. S., Kawakami, M. D., Kim, H. -S., Kleinman, M., Kloeck, D. A., Kudenchuk, P. J., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lee, H. C., Lin, Y. (., Lockey, A. S., Maconochie, I. K., Madar, R. J., Malta Hansen, C., Masterson, S., Matsuyama, T., Mckinlay, C. J. D., Meyran, D., Morgan, P., Morrison, L. J., Nadkarni, V., Nakwa, F. L., Nation, K. J., Nehme, Z., Nemeth, M., Neumar, R. W., Nicholson, T., Nikolaou, N., Nishiyama, C., Norii, T., Nuthall, G. A., O'Neill, B. J., Ong, Y. -K. G., Orkin, A. M., Paiva, E. F., Parr, M. J., Patocka, C., Pellegrino, J. L., Perkins, G. D., Perlman, J. M., Rabi, Y., Reis, A. G., Reynolds, J. C., Ristagno, G., Rodriguez-Nunez, A., Roehr, C. C., Rudiger, M., Sakamoto, T., Sandroni, Claudio, Sawyer, T. L., Schexnayder, S. M., Schmolzer, G. M., Schnaubelt, S., Semeraro, F., Skrifvars, M. B., Smith, C. M., Sugiura, T., Tijssen, J. A., Trevisanuto, D., Van De Voorde, P., Wang, T. -L., Weiner, G. M., Wyllie, J. P., Yang, C. -W., Yeung, J., Nolan, J. P., Berg, K. M., Burdick, M. C., Cartledge, S., Dawson, J. A., Elgohary, M. M., Ersdal, H. L., Finan, E., Flaatten, H. I., Flores, G. E., Fuerch, J., Garg, R., Gately, C., Goh, M., Halamek, L. P., Handley, A. J., Hatanaka, T., Hoover, A., Issa, M., Johnson, S., Kamlin, C. O., Ko, Y. -C., Kule, A., Leone, T. A., Mackenzie, E., Macneil, F., Montgomery, W., O'Dochartaigh, D., Ohshimo, S., Palazzo, F. S., Picard, C., Quek, B. H., Raitt, J., Ramaswamy, V. V., Scapigliati, Andrea, Shah, B. A., Stewart, C., Strand, M. L., Szyld, E., Thio, M., Topjian, A. A., Udaeta, E., Vaillancourt, C., Wetsch, W. A., Wigginton, J., Yamada, N. K., Yao, S., Zace, D., Zelop, C. M., Sandroni C. (ORCID:0000-0002-8878-2611), and Scapigliati A. (ORCID:0000-0002-4044-2343)

Abstract

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for futu

Published
2022

5. Part 7: Neonatal Resuscitation

Author

Wyllie, J., Perlman, J. M., Kattwinkel, J., Wyckoff, M. H., Aziz, K., Guinsburg, R., Kim, H. -S., Liley, H. G., Mildenhall, L., Simon, W. M., Szyld, E., Tamura, M., Velaphi, S., Boyle, D. W., Byrne, S., Colby, C., Capetta, Davis, Ersdal, H. L., Escobedo, M. B., Feng, Q., de Almeida, M. F., Halamek, L. P., Isayama, T., Kapadia, V. S., Lee, H. C., Mcgowan, M., Mcmillan, D. D., Niermeyer, S., O'Donnell, C. P. F., Rabi, Y., Ringer, S. A., Singhal, N., Stenson, B. J., Strand, M. L., Sugiura, T., Trevisanuto, D., Udaeta, E., Weiner, G. M., and Yeo, C. L.

Subjects
Emergency Medical Services, medicine.medical_treatment, Diseases, Heart Massage, Incubators, Pregnancy, Neonatal Resuscitation Program, Respiratory function, Brain Damage, Airway Management, Chronic, Evidence-Based Medicine, Respiration, Delivery room, Survival Rate, Observational Studies as Topic, medicine.anatomical_structure, Cardiopulmonary resuscitation, Newborns, Cardiopulmonary Resuscitation, Humans, Infant, Newborn, Consensus, Practice Guidelines as Topic, Anesthesia, Artificial, Breathing, Female, Cardiology and Cardiovascular Medicine, Delivery, medicine.medical_specialty, Monitoring, Physiology (medical), medicine, Physiologic, Intensive care medicine, Premature, business.industry, Delivery Rooms, Brain Damage, Chronic, Delivery, Obstetric, Emergencies, Heart Arrest, Incubators, Infant, Infant Care, Infant, Premature, Infant, Premature, Diseases, Monitoring, Physiologic, Pregnancy Complications, Respiration, Artificial, Infant, Obstetric, Newborn, Pulmonary respiration, Blood pressure, Vascular resistance, business, Neonatal resuscitation
Abstract

Newborn Transition The transition from intrauterine to extrauterine life that occurs at the time of birth requires timely anatomic and physiologic adjustments to achieve the conversion from placental gas exchange to pulmonary respiration. This transition is brought about by initiation of air breathing and cessation of the placental circulation. Air breathing initiates marked relaxation of pulmonary vascular resistance, with considerable increase in pulmonary blood flow and increased return of now-well-oxygenated blood to the left atrium and left ventricle, as well as increased left ventricular output. Removal of the low-resistance placental circuit will increase systemic vascular resistance and blood pressure and reduce right-to-left shunting across the ductus arteriosus. The systemic organs must equally and quickly adjust to the dramatic increase in blood pressure and oxygen exposure. Similarly, intrauterine thermostability must be replaced by neonatal thermoregulation with its inherent increase in oxygen consumption. Approximately 85% of babies born at term will initiate spontaneous respirations within 10 to 30 seconds of birth, an additional 10% will respond during drying and stimulation, approximately 3% will initiate respirations after positive-pressure ventilation (PPV), 2% will be intubated to support respiratory function, and 0.1% will require chest compressions and/or epinephrine to achieve this transition.1–3 Although the vast majority of newborn infants do not require intervention to make these transitional changes, the large number of births worldwide means that many infants require some assistance to achieve cardiorespiratory stability each year. Newly born infants who are breathing or crying and have good tone immediately after birth must be dried and kept warm so as to avoid hypothermia. These actions can be provided with the baby lying on the mother’s chest and should not require separation of mother and baby. This does not preclude the need for clinical assessment of the baby. …

Published
2015
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7. Establishment of functional residual capacity at birth: Observational study of 821 neonatal resuscitations.

Author

Ersdal HL, Eilevstjonn J, Perlman J, Gomo Ø, Moshiro R, Mdoe P, Kidanto H, Hooper SB, and Linde JE

Subjects
Functional Residual Capacity, Humans, Infant, Newborn, Positive-Pressure Respiration, Tidal Volume, Insufflation, Resuscitation
Abstract

Aim of the Study: Establishing functional residual capacity (FRC) during positive pressure ventilation (PPV) of apnoeic neonates is critical for survival. This may be difficult due to liquid-filled airways contributing to low lung compliance. The objectives were to describe initial PPV, changes in lung compliance and establishment of FRC in near-term/term neonates ≥36 weeks gestation at birth., Methods: Observational study of all neonatal resuscitations between 01.07.13 and 30.06.18 in a Tanzanian referral hospital. Perinatal events and characteristics were observed and recorded by trained research assistants. PPV were performed using self-inflating bag-masks without positive end-expiratory pressure (PEEP). Ventilation signals (pressure/flow), expired CO 2 (ECO 2 ) and heart rate were recorded by resuscitation monitors., Results: 19,587 neonates were born, 1451 received PPV, of these 821 of median (p25, p75) birthweight 3180 (2844, 3500) grams and gestation 38 (37, 40) weeks had ≥20 ventilations and complete datasets. There was a significant increase in expired volume (from 3.3 to 6.0 ml/kg), ECO 2 (0.3-2.4%), lung compliance (0.13-0.19 ml/kg/mbar) and heart rate (109-138 beats/min) over the first 20 PPVs. Inflation volume, time, and peak inflation pressure (PIP) were stable around 12-13 ml/kg, 0.45 s, and 36 mbar, respectively., Conclusions: The combination of increasing expired volumes, ECO 2 , and heart rate with decreasing inflation/expired volume ratios and constant PIP, suggests establishment of FRC during the first 20 PPVs in near-term/term neonates using a self-inflating bag-mask without PEEP, the most common device worldwide for ventilating non-breathing neonates. Initial lung compliance is low, and with short inflation times, higher than recommended PIP seem necessary to deliver adequate tidal volumes., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Published
2020
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8. Predictors of 24-h outcome in newborns in need of positive pressure ventilation at birth.

Author

Linde JE, Perlman JM, Øymar K, Schulz J, Eilevstjønn J, Thallinger M, Kusulla S, Kidanto HL, and Ersdal HL

Subjects
Asphyxia Neonatorum mortality, Birth Weight, Female, Follow-Up Studies, Gestational Age, Humans, Infant, Newborn, Male, Retrospective Studies, Rural Population, Survival Rate trends, Tanzania epidemiology, Time Factors, Treatment Outcome, Asphyxia Neonatorum therapy, Positive-Pressure Respiration methods, Resuscitation methods
Abstract

Background: Birth asphyxia, defined as 5-minute Apgar score <7 in apneic newborns, is a major cause of newborn mortality. Heart rate (HR) response to ventilation is considered an important indicator of effective resuscitation., Objectives: To describe the relationship between initial HR in apneic newborns, HR responses to ventilation and 24-h survival or death., Methods: In a Tanzanian hospital, data on all newborns ≥34 weeks gestational age resuscitated between June 2013-January 2017 were recorded using self-inflating bags containing sensors measuring ventilation parameters and expired CO 2 , dry-electrode electrocardiography sensors, and trained observers., Results: 757 newborns of gestational age 38 ± 2 weeks and birthweight 3131 ± 594 g were included; 706 survived and 51 died. Fetal HR abnormalities (abnormal, undetectable or not assessed) increased the risk of death almost 2-fold (RR = 1.77; CI: 1.07, 2.96, p = 0.027). For every beat/min increase in first detected HR after birth the risk of death was reduced by 2% (RR = 0.98; CI: 0.97, 0.99, p < 0.001). A decrease in HR to <100 beats/minute when ventilation was paused increased the risk of death almost 2-fold (RR = 1.76; CI: 0.96, 3.20, p = 0.066). An initial rapid increase in HR to >100 beats/min in response to treatment reduced the risk of dying by 75% (RR = 0.25; CI: 0.14, 0.44, p < 0.001). A 1% increase in expired CO 2 was associated with 28% reduced risk of death (RR = 0.72; CI: 0.62,0.85, p < 0.001)., Conclusions: The risk of death in apneic newborns can be predicted by the fetal HR (absent or abnormal), initial newborn HR (bradycardia), and the HR response to ventilation. These findings stress the importance of reliable fetal HR monitoring during labor and providing effective ventilation following birth to enhance survival., (Copyright © 2018. Published by Elsevier B.V.)

Published
2018
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9. The relation between given volume and heart rate during newborn resuscitation.

Author

Linde JE, Schulz J, Perlman JM, Øymar K, Blacy L, Kidanto H, and Ersdal HL

Subjects
Cross-Sectional Studies, Functional Residual Capacity physiology, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Midwifery, Positive-Pressure Respiration methods, Resuscitation methods, Tanzania, Heart Rate physiology, Positive-Pressure Respiration statistics & numerical data, Resuscitation standards, Tidal Volume physiology
Abstract

Background: During delivery room resuscitation of depressed newborns, provision of appropriate tidal volume (TV) with establishment of functional residual capacity (FRC) is essential for circulatory recovery. Effective positive pressure ventilation (PPV) is associated with a rapid increase in heart rate (HR). The relationship between delivery of TV and HR responses remains unclear., Objectives: The study objectives were to determine (1) the relationship between a given TV during initial PPV and HR responses of depressed newborns, and (2) the optimal delivered TV associated with a rapid increase in HR., Methods: In a Tanzanian rural hospital, ventilation and ECG signals were recorded during neonatal resuscitation and stored in Neonatal Resuscitation Monitors. Resuscitators without positive end-expiratory pressure were used for PPV. No oxygen was used. Perinatal events were observed and recorded by research assistants., Results: 215 newborns of gestational age 37.3±1.9 weeks and birth weight 3115±579g were included. There was a non-linear relationship between delivered TV and HR increase. TV of 9.3ml/kg produced the largest increase in HR during PPV. Frequent interruptions of PPV sequences to provide stimulation/suctioning occurred in all cases and were associated with further HR increases, especially for newborns with initial HR<100 beats/minute., Conclusions: There was a consistent positive relationship between HR increase and delivered TV. The unanticipated finding of a further increase in HR with PPV pauses to provide stimulation/suctioning suggests that most newborns were in primary rather than secondary apnea., (Copyright © 2017. Published by Elsevier B.V.)

Published
2017
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10. Timing of cord clamping in relation to start of breathing or ventilation among depressed neonates-an observational study.

Author

Ersdal HL, Linde J, Auestad B, Mduma E, Lyanga S, Svensen E, and Perlman J

Subjects
Female, Hospitals, Rural, Humans, Infant, Infant, Newborn, Logistic Models, Male, Resuscitation, Tanzania, Time Factors, Apnea therapy, Constriction, Infant Mortality, Positive-Pressure Respiration, Umbilical Cord
Abstract

Objectives: The optimal timing of cord clamping (CC) in nonbreathing neonates needing stabilisation/resuscitation remains unclear. The objective was to describe the relationship between time to CC, initiation of breathing or positive pressure ventilation (PPV) after stimulation/suction and 24-hour neonatal mortality/morbidity., Design: Observational study., Setting: A rural Tanzanian referral hospital., Population: Depressed nonbreathing newborns., Methods: Trained research assistants have observed every delivery (November 2009 through January 2014) using stop-watches and recorded data including fetal heart rate; time intervals from birth to CC and start of breathing or PPV and perinatal characteristics., Main Outcome Measures: Twenty-four-hour neonatal outcome (dead, admitted, normal)., Results: There were 19 863 liveborn infants; 16 770 (84.4%) initiated spontaneous respirations, 3093 (15.6%) received stimulation/suctioning to initiate breathing. However, 1269 (41.0%) neonates failed to breath and received PPV at 98 ± 66 seconds and CC at 39 ± 35 seconds after birth. Adverse outcomes in neonates receiving PPV included 126 (9.9%) deaths and 100 (7.8%) neonatal admissions. In 1146/1269 (90%) neonates, CC occurred before PPV and was associated with 209 (18%) deaths/admissions. In 98 (8%) neonates, CC followed initiation of PPV with 14 (14%) deaths/admissions (P = 0.328). By logistic modelling, initiation of PPV before versus after CC was not associated with death/admission when adjusted for time to PPV. The risk for death/admission increased by 12% for every 30-second delay in PPV (P = 0.001)., Conclusions: This observational study failed to demonstrate any relationship between time to CC and onset of breathing or initiation of PPV following stimulation/suction, and 24-hour outcome. Delay in initiation of PPV was significantly associated with death/admission., Tweetable Abstract: No relationship between time to cord clamp, breathing or ventilation and 24-hour deaths in depressed neonates., (© 2015 Royal College of Obstetricians and Gynaecologists.)

Published
2016
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11. Resuscitation in resource-limited settings.

Author

Ersdal HL and Singhal N

Subjects
Asphyxia Neonatorum mortality, Developing Countries, Humans, Infant Mortality, Infant, Newborn, Asphyxia Neonatorum therapy, Resuscitation education
Abstract

Intrapartum-related hypoxia leading to deaths and disabilities continues to be a global challenge, especially in resource-limited settings. Primary prevention during labour is likely to have a significant impact, but secondary prevention with focus on immediate basic stabilization at birth can effectively reduce a large proportion of these adverse outcomes as demonstrated in the resource-rich settings. Infants who fail to initiate and establish spontaneous respirations at birth often respond to early interventions such as drying, stimulation, clearing the airways, as well as bag mask ventilation applied within the first minute after birth. Simple resuscitation education such as 'Helping Babies Breathe', which focuses on the very basic steps and pays attention to comprehensive program development with local ownership and accountability, can help transfer competency into clinical practice and lead to sustainable programs impacting neonatal mortality and morbidity., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Published
2013
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12. [Symphysiotomy. A thought-provoking example of appropriate technique in the Third World].

Author

Ersdal HL and Bergström S

Subjects
Contraindications, Female, Humans, Pregnancy, Developing Countries, Symphysiotomy adverse effects, Symphysiotomy methods
Abstract

Cutting through the symphysis pubis cartilage as a means of widening the birth canal during long, drawn-out deliveries was probably common in Europe at the turn of the century and presumably occurred even later. As a result of progress in hygiene and clinical practice, Caesarean section has become much more common in such situations. In developing countries, where supervision of pregnant women is non-existent or extremely poor, Caesarean section can be a dangerous operation. Mortality figures around 1-3% are common, and the women are left with the unfavourable prognosis of a uterine scar. Therefore, symphysiotomy is still practised in settings where neither hygiene nor material resources permit. Caesarean section, because it is simple to perform and makes a negligible demand on resources.

Published
1997

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