Pulseless electrical activity: a misdiagnosed entity during asphyxia in newborn infants?
Sparsh Patel1,2, Po-Yin Cheung1,2, Anne Lee Solevåg2,3
1Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Summary
Electrocardiogram (ECG) assessment may be inaccurate for determining infant heart rate (HR) during resuscitation. A combination of auscultation, palpation, and pulse oximetry is more reliable for assessing asystole in newborns.
Area of Science:
- Neonatal Medicine
- Cardiology
- Resuscitation Science
Background:
- The 2015 neonatal resuscitation guidelines recommend electrocardiogram (ECG) for heart rate (HR) assessment at birth.
- Concerns exist regarding the accuracy of ECG in the delivery room setting.
Purpose of the Study:
- To compare the accuracy of ECG with auscultation in assessing asystole in asphyxiated piglets.
- To evaluate the reliability of different methods for determining heart rate during neonatal resuscitation.
Main Methods:
- Neonatal piglets underwent induced asphyxia to achieve asystole.
- Simultaneous monitoring of HR via ECG and carotid blood flow (CBF) was performed.
- Asystole was defined as zero CBF and compared with ECG and auscultation findings.
Main Results:
- In 43% of piglets, no CBF or audible heart sounds were detected, yet ECG showed HRs between 15-80/min.
- ECG, auscultation, and CBF agreed on asystole in only 26% of cases.
- Bradycardia (<100/min) was identified by all methods in 30% of piglets after 10 minutes of asphyxia.
Conclusions:
- ECG assessment for newborn heart rate during asphyxia can be inaccurate.
- A combined approach using auscultation, palpation, pulse oximetry, and ECG is recommended for reliable assessment.
Related Concept Videos
01:29Drug Dosing: Infants and Children
312
Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
312
01:13Finding Electric Potential From Electric Field
5.6K
For a system of charges, it is easy to calculate the system's potential because potential is a scalar quantity. However, in some instances where calculating the electric field is more straightforward than finding the potential, the electric field is used to calculate the system's potential. For a positive charge, the electric field is radially outward, and the potential is positive at any finite distance from the positive charge. In such an electric field, the motion away from the...
5.6K
01:12Determining Electric Field From Electric Potential
5.0K
The electric field and electric potential are related to each other. If the electric field at various points in the region of interest is known, it can be used to calculate the electric potential difference between any two points. Similarly, if the electric potential is known for various points, then it is possible to calculate the electric field.
In general, regardless of whether the electric field is uniform, it points in the direction of decreasing potential because the force on a positive...
In general, regardless of whether the electric field is uniform, it points in the direction of decreasing potential because the force on a positive...
5.0K
01:09Electric Potential Energy in a Uniform Electric Field
6.5K
When an electric field accelerates a free positive charge, it acquires kinetic energy. This process is analogous to an object being accelerated by a gravitational field as if the charge were going down an electrical hill where its electric potential energy is converted into kinetic energy, although, of course, the sources of the forces are very different. The electrostatic or Coulomb force acting on the positive test charge is conservative, which means that the work done on a test charge is...
6.5K
01:21Electrical Systems
766
In electrical engineering, the analysis of networks composed of passive linear components — resistors (R), capacitors (C), and inductors (L) — is fundamental. These components are organized into circuits where the relationship between input and output can be analyzed using transfer functions. The transfer function of an RLC circuit, which relates the voltage across a capacitor to the input voltage, can be derived using Kirchhoff's laws.
To derive the transfer function, consider an RLC...
To derive the transfer function, consider an RLC...
766
01:11Electric Charges
23.0K
From lightning during thunderstorms to electronic devices, the phenomenon of electromagnetism is all around us. The electromagnetic force is one of the four fundamental forces of nature. It has been known to humanity in various forms for thousands of years. For example, the ancient Greek philosopher Thales of Miletus recorded his experiments on static electricity using amber and fur in the sixth century BC.
The English physicist William Gilbert studied the phenomenon of static electricity in...
The English physicist William Gilbert studied the phenomenon of static electricity in...
23.0K