Resuscitative interventions during simulated asystole deviate from the recommended timeline.
Scarlett McKinsey1, Jeffrey M Perlman1
1Department of Pediatrics, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA.
Archives of Disease in Childhood. Fetal and Neonatal Edition
|September 25, 2015
Summary
Neonatal resuscitation teams often delay critical interventions for asystolic infants, including adrenaline administration, impacting patient outcomes. Adherence to Neonatal Resuscitation Programme (NRP) guidelines requires improvement in simulated delivery room scenarios.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Medical Simulation
Background:
- Adherence to Neonatal Resuscitation Programme (NRP) guidelines is crucial for managing asystolic infants.
- Delivery room resuscitation requires timely and coordinated interventions.
Purpose of the Study:
- To evaluate adherence to NRP guidelines during intensive resuscitation of asystolic infants in a simulated setting.
- To determine the time to the first dose of intravenous adrenaline in these scenarios.
Main Methods:
- Ten neonatal fellows participated in a simulated delivery room scenario involving an asystolic infant.
- All interventions were timed and compared against the NRP recommended timeline (RT).
Main Results:
- While initial steps like ventilation were timely, asystole identification occurred in only 60% of cases.
- Cardiopulmonary resuscitation initiation was delayed by 60 seconds, and umbilical catheterization took twice the recommended time.
- The first dose of intravenous adrenaline was administered 120 seconds later than recommended, with resuscitation discontinuation occurring significantly after adrenaline administration.
Conclusions:
- Critical resuscitation steps, particularly adrenaline administration, are frequently delayed, indicating a gap in guideline adherence.
- Accurate and timely identification of asystole by auscultation is challenging and can delay interventions.
- Recommendations for resuscitation discontinuation should specify effective resuscitation metrics, such as timely intubation and adrenaline administration, with the timer starting post-adrenaline.
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