Resuscitator's perceptions and time for corrective ventilation steps during neonatal resuscitation.

Area of Science:

• Neonatal Resuscitation
• Pediatric Emergency Medicine
• Cardiopulmonary Physiology

Background:

• The 2010 Neonatal Resuscitation Program (NRP) guidelines integrated ventilation corrective steps (MRSOPA) into the resuscitation algorithm.
• The clinical utility, provider perception, and time efficiency of these MRSOPA steps remain unevaluated.

Purpose of the Study:

• To evaluate neonatal providers' preference for performing ventilation corrective steps (MRSOPA).
• To assess the time taken for MRSOPA maneuvers and time to chest compression onset during simulated neonatal resuscitation.
• To compare provider responses in scenarios of bradycardia versus cardiac arrest.

Main Methods:

• 35 NRP-certified providers participated in two simulated neonatal resuscitation scenarios: perinatal asphyxia with bradycardia and cardiac arrest.
• Data collected included preference for corrective measures, time for MRSOPA, and time to chest compression initiation.
• Providers' professional roles and experience levels were also considered.

Main Results:

• The average time to perform MRSOPA was 48.9 ± 21.4 seconds.
• Providers were less likely to perform corrective steps and more likely to proceed to endotracheal intubation in cardiac arrest compared to bradycardia.
• Chest compressions were initiated significantly sooner in cardiac arrest (89 ± 24 s) than in bradycardia (122 ± 23 s).

Conclusions:

• Mask ventilation with corrective steps is crucial for most neonatal resuscitations.
• Neonatal providers prioritize early endotracheal intubation and chest compressions in asystolic cardiac arrest.
• Implementing corrective ventilation steps may delay chest compressions and potentially impede the return of spontaneous circulation in severe cardiovascular compromise.