We describe a case highlighting several controversial and important topics regarding neonatal cardiopulmonary resuscitation (CPR). Current neonatal guidelines recommend a 3:1 compression:ventilation ratio; however, the most effective ratio of delivering chest compressions (CC) remains controversial. We report a case of a male infant at 24 weeks' postmenstrual age weighing 650 g on a background of preterm labor. At initial assessment the infant appeared floppy and apneic with a heart rate (HR) of 50-60 beats/min. Mask ventilation was ineffective, thus continuous CC (90/min) with asynchronous ventilations (60/min) was started. HR, blood pressure, oxygen saturation, cerebral oxygenation, respiratory function, and exhaled carbon dioxide (ECO2) were continuously measured during CPR. Return of spontaneous circulation defined as HR >60/min was achieved after 90 s of CPR. Mask leak significantly increased during CC. During bradycardia (HR ∼50/min), ECO2 indicated correct tube placement and an increase of ECO2 >12 mm Hg was associated with rapid increase in HR >60/min.

Keywords:
Infants, Newborn, Delivery room, Neonatal resuscitation, Chest compression
1.
Kattwinkel J, Perlman J, Aziz K, Colby C, Fairchild K, Gallagher J, Hazinski M, Halamek L, Kumar P, Little G, McGowan J, Nightengale B, Ramirez M, Ringer S, Simon W, Weiner G, Wyckoff M, Zaichkin J: Part 15: neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S909-S919.
2.
Berg RA, Hilwig RW, Kern KB, Ewy GA: ‘Bystander' chest compressions and assisted ventilation independently improve outcome from piglet asphyxial pulseless ‘cardiac arrest'. Circulation 2000;101:1743-1748.
3.
Schmölzer GM, O'Reilly M, LaBossiere J, Lee TF, Cowan S, Nicoll J, Bigam DL, Cheung PY: 3:1 compression to ventilation ratio versus continuous chest compression with asynchronous ventilation in a porcine model of neonatal resuscitation. Resuscitation, Epub ahead of print.
4.
Schmölzer GM, Kamlin OC, O'Donnell CP, Dawson JA, Morley CJ, Davis PG: Assessment of tidal volume and gas leak during mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed 2010;95:F393-F397.
5.
Schmölzer GM, Morley CJ, Wong C, Dawson JA, Kamlin COF, Donath SM, Hooper S, Davis PG: Respiratory function monitor guidance of mask ventilation in the delivery room: a feasibility study. J Pediatr 2012;160:377-381.e2.
6.
Solevåg AL, Madland JM, Gjærum E, Nakstad B: Minute ventilation at different compression to ventilation ratios, different ventilation rates; and continuous chest compressions with asynchronous ventilation in a newborn manikin. Scand J Trauma Resusc Emerg Med 2012;20:73.
7.
Nicoll J, O'Reilly M, LaBossiere J, Lee TF, Cowan S, Bigam DL, Cheung PY, Schmölzer GM: Effect of cardiac output changes on exhaled carbon dioxide in newborn piglets. Resuscitation, Epub ahead of print.
8.
Chalak LF, Barber CA, Hynan L, Garcia D, Christie L, Wyckoff MH: End-tidal CO₂ detection of an audible heart rate during neonatal cardiopulmonary resuscitation after asystole in asphyxiated piglets. Pediatr Res 2011;69:401-405.
9.
Kamlin C, O'Donnell CPF, Everest NJ, Davis PG, Morley CJ: Accuracy of clinical assessment of infant heart rate in the delivery room. Resuscitation 2006;71:319-321.
10.
Hooper SB, Fouras A, Siew ML, Wallace MJ, Kitchen MJ, Pas AB, Klingenberg C, Lewis RA, Davis PG, Morley CJ, Schmölzer GM: Expired CO2 levels indicate degree of lung aeration at birth. PLoS One 2013;8:e70895.
11.
Fuchs H, Lindner W, Uschko A, Trischberger T, Schmid M, Hummler HD: Cerebral oxygenation in very low birth weight infants supported with sustained lung inflations after birth. Pediatr Res 2011;70:176-180.
12.
Binder C, Urlesberger B, Avian A, Pocivalnik M, Müller W, Pichler G: Cerebral and peripheral regional oxygen saturation during postnatal transition in preterm neonates. J Pediatr 2013;63:394-399.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.