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Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
Pediatric resuscitation
1University Children's Hospital, Dr v Haunersches Kinderspital, Munich, Germany. tnicolai@med.uni-muenchen.de
Insights
New guidelines recommend room air for neonatal resuscitation, avoiding 100% oxygen unless necessary. Pediatric intubation by first responders is discouraged, and hypothermia shows promise for neurologically depressed neonates.
Area of Science:
- Pediatric Emergency Medicine
- Neonatal Resuscitation
- Critical Care
Background:
- The 2005 International Liaison Committee on Resuscitation (ILCOR) guidelines introduced significant updates to pediatric resuscitation protocols.
- Ongoing research has addressed previously unresolved issues, necessitating a review of current practices.
Purpose of the Study:
- To discuss the impact of new studies on pediatric resuscitation, focusing on oxygen use, intubation, and hypothermia.
- To provide an evidence-based overview of recent advancements in neonatal and pediatric critical care.
Main Methods:
- Review of recent studies and ILCOR guidelines.
- Analysis of prospective studies on neonatal resuscitation and pediatric pre-hospital care.
- Evaluation of evidence regarding therapeutic hypothermia in neonates.
Main Results:
- Studies consistently show room air is superior to 100% oxygen for neonatal resuscitation.
- Prospective data suggest pre-hospital pediatric intubation by first responders is associated with increased risk and should be avoided.
- Therapeutic hypothermia is linked to improved neurological outcomes in neonates experiencing perinatal asphyxia.
Conclusions:
- Neonatal resuscitation of 'depressed' infants should commence with less than 100% oxygen, escalating only if bradycardia and cyanosis persist.
- First responders lacking pediatric intubation training should prioritize other resuscitation measures, as intubation attempts may be detrimental.
- Therapeutic hypothermia for neonates post-birth asphyxia should be implemented within controlled studies or specialized centers following established protocols.
Purpose Of Review:
The new International Liaison Committee on Resuscitation documents, published in 2005, include important changes in pediatric resuscitation. Some issues that were left pending have since been supplemented with new studies. Their impact will be discussed here.
Recent Findings:
Studies on oxygen use for neonatal resuscitation have consistently found room air to be superior to 100% oxygen. Prospective studies indicate that intubation by first responders in preclinical resuscitation of children is dangerous and should probably be avoided. New studies point to a better neurological outcome with hypothermia in neurologically depressed neonates after perinatal asphyxia.
Summary:
Resuscitation of 'depressed' near-term neonates should be started with an oxygen content of less than 100%, and only change to 100% if the child remains bradycardic and cyanotic. A neonate who can be resuscitated with room air will receive no benefit from 100% oxygen and may even have a worse outcome. If the first responder in a pediatric emergency is out of training with pediatric intubation he or she should feel reassured that resuscitation without an attempt at endotracheal intubation is acceptable. Presently, hypothermia in neonates after birth asphyxia should be used within controlled studies, or at least follow the protocols of published studies and be performed in specialized centers.
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