European Resuscitation Council Guidelines for Resuscitation 2010 ...

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1388 D. Biarent et al. / Resuscitation 81 (2010) 1364–1388 401. Dudley NC, Hansen KW, Furnival RA, Donaldson AE, Van Wagenen KL, Scaife ER. The effect of family presence on the efficiency of pediatric trauma resuscitations. Ann Emerg Med 2009;53:777–84, e3. 402. Tinsley C, Hill JB, Shah J, et al. Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit. Pediatrics 2008;122: e799–804. 403. Mangurten J, Scott SH, Guzzetta CE, et al. Effects of family presence during resuscitation and invasive procedures in a pediatric emergency department. J Emerg Nurs 2006;32:225–33. 404. McGahey-Oakland PR, Lieder HS, Young A, et al. Family experiences during resuscitation at a children’s hospital emergency department. J Pediatr Health Care 2007;21:217–25. 405. Jones M, Qazi M, Young KD. Ethnic differences in parent preference to be present for painful medical procedures. Pediatrics 2005;116:e191–7. 406. Boie ET, Moore GP, Brummett C, Nelson DR. Do parents want to be present during invasive procedures performed on their children in the emergency department? A survey of 400 parents. Ann Emerg Med 1999;34: 70–4. 407. Andrews R, Andrews R. Family presence during a failed major trauma resuscitation attempt of a 15-year-old boy: lessons learned [see comment]. J Emerg Nurs 2004;30:556–8. 408. Dill K, Gance-Cleveland B, Dill K, Gance-Cleveland B. With you until the end: family presence during failed resuscitation. J Specialists Pediatr Nurs: JSPN 2005;10:204–7. 409. Gold KJ, Gorenflo DW, Schwenk TL, et al. Physician experience with family presence during cardiopulmonary resuscitation in children [see comment]. Pediatr Crit Care Med 2006;7:428–33. 410. Duran CR, Oman KS, Abel JJ, Koziel VM, Szymanski D. Attitudes toward and beliefs about family presence: a survey of healthcare providers, patients’ families, and patients. Am J Crit Care 2007;16:270–9. 411. Meyers TA, Eichhorn DJ, Guzzetta CE, et al. Family presence during invasive procedures and resuscitation. Am J Nurs 2000;100:32–42, quiz 3. 412. O’Connell KJ, Farah MM, Spandorfer P, et al. Family presence during pediatric trauma team activation: an assessment of a structured program. Pediatrics 2007;120:e565–74. 413. Engel KG, Barnosky AR, Berry-Bovia M, et al. Provider experience and attitudes toward family presence during resuscitation procedures. J Palliative Med 2007;10:1007–9. 414. Holzhauser K, Finucane J, De Vries S. Family presence during resuscitation: a randomised controlled trial of the impact of family presence. Australasian Emerg Nurs J 2005;8:139–47. 415. Doyle CJ, Post H, Burney RE, Maino J, Keefe M, Rhee KJ. Family participation during resuscitation: an option. Ann Emerg Med 1987;16:673–5. 416. Meyers TA, Eichhorn DJ, Guzzetta CE. Do families want to be present during CPR? A retrospective survey. J Emerg Nurs 1998;24:400–5. 417. Hanson C, Strawser D. Family presence during cardiopulmonary resuscitation: foote Hospital emergency department’s nine-year perspective. J Emerg Nurs 1992;18:104–6. 418. Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, Egleston CV, Prevost AT. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet 1998;352:614–7. 419. Compton S, Madgy A, Goldstein M, et al. Emergency medical service providers’ experience with family presence during cardiopulmonary resuscitation. Resuscitation 2006;70:223–8. 420. Beckman AW, Sloan BK, Moore GP, et al. Should parents be present during emergency department procedures on children, and who should make that decision? A survey of emergency physician and nurse attitudes. Acad Emerg Med 2002;9:154–8. 421. Eppich WJ, Arnold LD. Family member presence in the pediatric emergency department. Curr Opin Pediatr 2003;15:294–8. 422. Eichhorn DJ, Meyers TA, Mitchell TG, Guzzetta CE. Opening the doors: family presence during resuscitation. J Cardiovasc Nurs 1996;10:59–70. 423. Jarvis AS. Parental presence during resuscitation: attitudes of staff on a paediatric intensive care unit. Intensive Crit Care Nurs 1998;14:3–7.
Resuscitation 81 (2010) 1389–1399 Contents lists available at ScienceDirect Resuscitation journal homepage: www.elsevier.com/locate/resuscitation European Resuscitation Council Guidelines for Resuscitation 2010 Section 7. Resuscitation of babies at birth Sam Richmond a,1 , Jonathan Wyllie b,∗,1 a Neonatology, Sunderland Royal Hospital, Sunderland, UK b Neonatology and Paediatrics, The James Cook University Hospital, Middlesbrough, UK Introduction The following guidelines for resuscitation at birth have been developed during the process that culminated in the 2010 International Consensus Conference on Emergency Cardiovascular Care (ECC) and Cardiopulmonary Resuscitation (CPR) Science with Treatment Recommendations. 1,2 They are an extension of the guidelines already published by the ERC 3 and take into account recommendations made by other national and international organisations. Summary of changes since 2005 Guidelines The following are the main changes that have been made to the guidelines for resuscitation at birth in 2010: • For uncompromised babies, a delay in cord clamping of at least 1 min from the complete delivery of the infant, is now recommended. As yet there is insufficient evidence to recommend an appropriate time for clamping the cord in babies who are severely compromised at birth. • For term infants, air should be used for resuscitation at birth. If, despite effective ventilation, oxygenation (ideally guided by oximetry) remains unacceptable, use of a higher concentration of oxygen should be considered. • Preterm babies less than 32 weeks gestation may not reach the same arterial blood oxygen saturations in air as those achieved by term babies. Therefore blended oxygen and air should be given judiciously and its use guided by pulse oximetry. If a blend of oxygen and air is not available use what is available. • Preterm babies of less than 28 weeks gestation should be completely covered in a food-grade plastic wrap or bag up to their necks, without drying, immediately after birth. They should then be nursed under a radiant heater and stabilised. They should ∗ Corresponding author. E-mail address: jonathan.wyllie@stees.nhs.uk (J. Wyllie). 1 Both authors contributed equally to this manuscript and share first authorship. remain wrapped until their temperature has been checked after admission. For these infants delivery room temperatures should be at least 26 ◦ C. • The recommended compression:ventilation ratio for CPR remains at 3:1 for newborn resuscitation. • Attempts to aspirate meconium from the nose and mouth of the unborn baby, while the head is still on the perineum, are not recommended. If presented with a floppy, apnoeic baby born through meconium it is reasonable to rapidly inspect the oropharynx to remove potential obstructions. If appropriate expertise is available, tracheal intubation and suction may be useful. However, if attempted intubation is prolonged or unsuccessful, start mask ventilation, particularly if there is persistent bradycardia. • If adrenaline (epinephrine) is given then the intravenous route is recommended using a dose of 10–30 gkg −1 . If the tracheal route is used, it is likely that a dose of at least 50–100 gkg −1 will be needed to achieve a similar effect to 10 gkg −1 intravenously. • Detection of exhaled carbon dioxide in addition to clinical assessment is recommended as the most reliable method to confirm placement of a tracheal tube in neonates with spontaneous circulation. • Newly born infants born at term or near-term with evolving moderate to severe hypoxic–ischemic encephalopathy should, where possible, be offered therapeutic hypothermia. This does not affect immediate resuscitation but is important for post-resuscitation care. The guidelines that follow do not define the only way that resuscitation at birth should be achieved; they merely represent a widely accepted view of how resuscitation at birth can be carried out both safely and effectively (Fig. 7.1). Preparation Relatively few babies need any resuscitation at birth. Of those that do need help, the overwhelming majority will require only assisted lung aeration. A small minority may need a brief period of chest compressions in addition to lung aeration. Of 100,000 babies born in Sweden in 1 year, only 10 per 1000 (1%) babies of 2.5 kg or more appeared to need resuscitation at delivery. 4 Of those babies 0300-9572/$ – see front matter © 2010 European Resuscitation Council. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.resuscitation.2010.08.018
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