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Session Title: NRP Current Issues Seminar Session Number: C0006 Myra H. Wyckoff, MD, FAAP UT Southwestern Medical Center at Dallas. Update on the International Liaison Committee on Resuscitation (ILCOR) The 2015 Scientific Review is almost here!. Faculty Disclosure Information

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slide1

Session Title: NRP Current Issues Seminar

Session Number: C0006

Myra H. Wyckoff, MD, FAAP

UT Southwestern Medical Center at Dallas

slide2

Update on the International Liaison Committee on Resuscitation (ILCOR)The 2015 Scientific Review is almost here!

slide3

Faculty Disclosure Information

In the past 12 months, I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity.I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

achieving consensus on resuscitation science
Achieving Consensus on Resuscitation Science

Australian

Resuscitation

Council

Since 2000, the AAP with the American Heart Association, participates with the International Liaison Committee on Resuscitation (ILCOR) for a complete review of resuscitation science every 5 years.

32 new questions being reviewed for 2015

guidelines for neonatal resuscitation
Guidelines for Neonatal Resuscitation

Guidelines available online October 19, 2015

Printed Guidelines supplement will be published in Circulation,Resuscitation and likely Pediatrics

Will be able to download at: www.heart.org/cpr

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Initial Assessment and Intervention

CO2 detector, pulse oximetry

O2 use during resuscitation

O2 saturation targets

Meconium stained amniotic fluid

Umbilical Cord Clamping

Prenatal prediction of respiratory

compromise

Circulatory Support

Compression/Ventilation ratios

2 Thumb vs 2 Finger CPR

Epinephrine dosing

IO vs IV

IV vs ETT drugs

Naloxone

Sodium Bicarbonate

Volume Resuscitation

Supportive Therapy

Warming Adjuncts

  • Ventilation Strategies
  • CPAP and IPPV
  • LMA
  • Comparing IPPV devices
  • Ventilation parameters for neonates

Postresuscitation Management

Hypothermia (induced)

Maternal fever

Supplemental glucose

Monitoring During and After Intubation

Bradycardia and CO2 monitoring

CO2 detection

Ventilation volume monitoring

Withholding or Stopping Resuscitation Efforts

Duration of CPR with asystole and outcome

Futile resuscitation rules

Teaching Resuscitation

High fidelity training

Impact of debriefing on team performance

slide9

Circulatory Support

Compression/Vent ratios

2 Thumb vs 2 Finger CPR

Epinephrine dosing

IO vs IV

IV vs ETT drugs

Naloxone

Sodium Bicarbonate

Volume Resuscitation

Initial Assessment and Intervention

CO2 detector, pulse oximetry

O2 use during CPR

O2 saturation targets for preterms

Meconium suctioning of the non-

vigorous infants

Umbilical Cord Clamping for non-

vigorous infants

Prenatal prediction of respiratory

compromise

Supportive Therapy

Warming Adjuncts

Impact of Maternal Temp

Impact of Hypothermia

Impact of Hyperthermia

  • Ventilation Strategies
  • CPAP and IPPV
  • LMA
  • Comparing IPPV devices
  • PEEP vs no PEEP
  • Sustained Inflation

Postresuscitation Management

Hypothermia (induced)

Maternal fever

Supplemental glucose

Monitoring During and After Intubation

Bradycardia and CO2 monitoring

CO2 detection

Ventilation volume monitoring

Withholding or Stopping Resuscitation Efforts

Apgar score of 0 at 10 minutes

Futile resuscitation

Teaching Resuscitation

Frequency of training

Impact of debriefing on team performance

hot topics in neonatal resuscitation
Hot Topics in Neonatal Resuscitation
  • Should cord clamping be delayed for neonates who are non-vigorous?
  • How to best maintain euthermia of the neonate in the delivery room?
  • Does intubation and suction benefit the non-vigorous meconium stained neonate?
  • How should oxygen be used for premature neonates in the delivery room?
  • How to deliver initial breaths to a premature neonate in the delivery room?
handling of the cord
Handling of the Cord
  • In preterm neonates including those who require resuscitation does delayed cord clamping versus immediate cord clamping improve outcome?
  • In very preterm infants does milking the cord versus immediate clamping improve outcomes?
temperature management in the dr
Temperature Management in the DR
  • In non-asphyxiated babies at birth, does maintenance of normothermia (Core temp>=36.5 degrees and <=37.5 degrees centigrade) from delivery to admission, compared with hypothermia (< 36ºC) or hyperthermic (> 37.5ºC), change outcome.
  • Among preterm neonates who are under radiant warmers in the hospital, does increased room temperature, thermal mattress, or another intervention, compared with plastic wraps alone, change outcome?

77 F

suctioning of the non vigorous meconium stained infant
Suctioning of the Non-vigorous Meconium Stained Infant
  • Does suctioning of the trachea improve outcomes (prevent meconium aspiration syndrome, etc.) for non-vigorous meconium stained infants?
handling of the cord1
Handling of the Cord
  • In preterm neonates including those who require resuscitation does delayed cord clamping versus immediate cord clamping improve outcome?
  • In very preterm infants does milking the cord versus immediate clamping improve outcomes?
delivery room o 2
Delivery Room O2
  • Among preterm newborns (< 37 wks GA) who receive PPV in the delivery room, does low initial oxygen (21-30%) as opposed to high initial high oxygen (80-100%) decrease mortality, BPD, ROP, neurologic deficit, time to HR > 100 bpm
how to deliver initial breaths to a preterm infant in the dr
How to Deliver Initial Breaths to a Preterm Infant in the DR
  • In term/preterm newborn infants who do not establish spontaneous respiration at birth, does the administration of one or more pressure-limited sustained lung inflations lasting 15-30s as compared to intermittent positive pressure ventilation with short inspiratory times (< 1s) for 30-60s improve outcome?
great news
Great News!
  • There is lots of new science to review and incorporate into the new ILCOR guidelines!
ackowledgments
Ackowledgments
  • Thanks to the AAP for several of the photos used for illustration