Respiratory function and near infrared spectroscopy recording during cardiopulmonary resuscitation in an extremely preterm newborn.
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.
Faculty of Science, McGill University, Quebec, Que., Canada.
Elliott S
ES
Li
Po-Yin
PY
Cheung
Gerhard
G
Pichler
Khalid
K
Aziz
Georg M
GM
Schmölzer
D001238:Asphyxia Neonatorum / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D001944:Breath Tests; D002245:Carbon Dioxide / Q000378:metabolism; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects; D002560:Cerebrovascular Circulation; D045853:Exhalation; D005865:Gestational Age; D006439:Hemodynamics; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008168:Lung / Q000503:physiopathology*; D008297:Male; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000097:blood*; D011237:Predictive Value of Tests; D012121:Respiration, Artificial; D019265:Spectroscopy, Near-Infrared; D016896:Treatment Outcome
D015415:Biomarkers; D002245:Carbon Dioxide; D010100:Oxygen