New study evaluates current neonatal resuscitation guidelines

DENVER, April 22, 2022 – A new randomized control trial compares the current recommendations of ventilation and chest compression versus ventilation during neonatal resuscitation using an ovine model of bradycardia. Findings from the study will be presented during the Pediatric Academic Societies (PAS) 2022 Meeting, taking place April 21-25 in Denver.

 

Current guidelines recommend initiating chest compressions when the heart rate is less than 60 beats per minute after 30 seconds of effective ventilation. Neonates receiving chest compressions are at high risk for mortality and poor neurodevelopmental outcome. While chest compressions provide circulatory support, its efficacy in neonatal bradycardia secondary to its asynchronous nature to the existing cardiac rhythm remains unknown and could be deleterious. Addressing neonatal asphyxia with adequate ventilation could reduce the need for chest compressions and improve overall outcomes.

 

The pilot study suggests that optimizing ventilation and avoiding chest compressions for bradycardia in neonatal resuscitation could reduce the need for chest compressions and improve gas exchange in an ovine model. With these data, the researchers intend to evaluate lowering the cut-off to initiate chest compressions for neonatal bradycardia for heart rates less than 30 beats per minute versus less than 60 beats per minute using both term and preterm models of bradycardia.

 

“Most neonates transition successfully at birth and establish normal breathing with lungs as the site of gas exchange,” said Mausma Bawa, MD, fellow physician at Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo. “Neonates who require extensive resuscitation are at higher risk of morbidity and mortality. Currently, International Liaison Committee on Resuscitation (ILCOR)/Neonatal Resuscitation Program (NRP) recommends initiating chest compressions when the heart rate is less than 60 after 30 seconds of effective positive pressure ventilation through a properly secured advanced airway. Since there is no evidence for this current practice, our study evaluates the current recommendations. Our pilot study using a term ovine model suggests that focusing on ventilation for bradycardia during neonatal resuscitation could reduce the need for chest compressions.”

 

Dr. Bawa will present “A Randomized Control Trial Comparing the Current Recommendations of Ventilation and Chest Compression vs. Ventilation During Neonatal Resuscitation Using an Ovine Model of Bradycardia” on Saturday, April 23 at 9 a.m. MDT. Reporters interested in an interview with Dr. Bawa should contact PAS2022@piercom.com.

 

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

 

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About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting is the premier North American scholarly child health meeting. The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit www.pas-meeting.org. Follow us on Twitter @PASMeeting, Instagram PASMeeting and #PAS2022, and like us on Facebook PASMeeting. 

 

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Abstract: A Randomized Control Trial Comparing the Current Recommendations of Ventilation and Chest Compression vs. Ventilation During Neonatal Resuscitation Using an Ovine Model of Bradycardia

 

Presenting Author

Mausma Bawa, MD

 

Organization

Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo

 

Topic

Neonatal/Infant Resuscitation

 

Background

Current guidelines recommend initiating chest compressions (CC) when heart rate (HR) is < 60bpm after 30s of effective ventilation. Neonates receiving CC are at high risk for mortality and poor neurodevelopmental outcome. While CC provides circulatory support, its efficacy in neonatal bradycardia secondary to its asynchronous nature to the existing cardiac rhythm remains unknown and could be deleterious. Addressing neonatal asphyxia with adequate ventilation (PPV) could reduce the need for CC and improve overall outcomes.

 

Objective

To evaluate the effect of current neonatal resuscitation program guidelines (CONTROL) i.e. PPV for 30s followed by CC, endotracheal epinephrine (ETTEPI), and intravenous epinephrine (IVEPI) vs (STUDY) continuing PPV with ETTEPI and IVEPI; initiate CC only if bradycardia continues to full arrest (HR 0) with resuscitation until return of spontaneous circulation (ROSC) or until 20 min. Our objectives were to evaluate the effect of these interventions between the groups on i) timing of ROSC ii) frequency of requiring CC iii) gas exchange and hemodynamics using a neonatal bradycardia ovine model.

 

Design/Methods

Thirty near-term lambs (138-140d) were randomized to control or study groups after instrumentation (Fig 1A). Data from 6 lambs in each group was included based on criteria (Fig 1A).The timing and incidence of ROSC, need for CC, blood gas parameters, peak coronary (CoBF), peak left carotid (CaBF), peak left pulmonary blood flow (PBF) were recorded.

 

Results

The characteristics of the lambs are shown (Fig 1B). Compared to controls, time to achieve ROSC was non significantly shorter in the study group (Fig 1B). In the study group, 1/6 lambs required CC with a significant difference in rates of CC compared to controls (6/6, p - 0.015). The asynchronous CC in the control group led to the loss of intrinsic activity before ROSC (Fig 2 A). At ROSC, the study group had significantly lower arterial carbon dioxide as well as higher arterial oxygenation signifying better gas exchange with effective ventilation in the study group compared to the control group (Fig 2B).The peak CoBF, CaBF, PBF were non significantly lower in the control group during CC compared to the study group (Fig 3)

 

Conclusion(s)

Our pilot study suggests that optimizing ventilation and avoiding CC for bradycardia in neonatal resuscitation could reduce the need for CC and improve gas exchange in an ovine model. With these data, we intend to evaluate lowering the cut-off to initiate CC for neonatal bradycardia for HR < 30 bpm vs. < 60 bpm using both term and preterm models of bradycardia.

 

Tables and Images

Fig 1 Bradycardia.jpg

Fig 2 Bradycardia.jpg

Fig 3 Bradycardia.jpg

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