European Resuscitation Council Guidelines for Resuscitation ... - CPR

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18 de 0ctubre de 2010 www.elsuapdetodos.com1388 D. Biarent et al. / Resuscitation 81 (2010) 1364–1388401. Dudley NC, Hansen KW, Furnival RA, Donaldson AE, Van Wagenen KL, ScaifeER. 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 cardiopulmonaryresuscitation in a pediatric intensive care unit. Pediatrics 2008;122:e799–804.403. Mangurten J, Scott SH, Guzzetta CE, et al. Effects of family presence duringresuscitation and invasive procedures in a pediatric emergency department. JEmerg Nurs 2006;32:225–33.404. McGahey-Oakland PR, Lieder HS, Young A, et al. Family experiences duringresuscitation at a children’s hospital emergency department. J Pediatr HealthCare 2007;21:217–25.405. Jones M, Qazi M, Young KD. Ethnic differences in parent preference to bepresent for painful medical procedures. Pediatrics 2005;116:e191–7.406. Boie ET, Moore GP, Brummett C, Nelson DR. Do parents want to bepresent during invasive procedures performed on their children in the emergencydepartment? A survey of 400 parents. Ann Emerg Med 1999;34:70–4.407. Andrews R, Andrews R. Family presence during a failed major trauma resuscitationattempt of a 15-year-old boy: lessons learned [see comment]. J EmergNurs 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: JSPN2005;10:204–7.409. Gold KJ, Gorenflo DW, Schwenk TL, et al. Physician experience with family presenceduring cardiopulmonary resuscitation in children [see comment]. PediatrCrit Care Med 2006;7:428–33.410. Duran CR, Oman KS, Abel JJ, Koziel VM, Szymanski D. Attitudes toward andbeliefs 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 invasiveprocedures and resuscitation. Am J Nurs 2000;100:32–42, quiz 3.412. O’Connell KJ, Farah MM, Spandorfer P, et al. Family presence during pediatrictrauma team activation: an assessment of a structured program. Pediatrics2007;120:e565–74.413. Engel KG, Barnosky AR, Berry-Bovia M, et al. Provider experience and attitudestoward family presence during resuscitation procedures. J Palliative Med2007;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. AustralasianEmerg Nurs J 2005;8:139–47.415. Doyle CJ, Post H, Burney RE, Maino J, Keefe M, Rhee KJ. Family participationduring resuscitation: an option. Ann Emerg Med 1987;16:673–5.416. Meyers TA, Eichhorn DJ, Guzzetta CE. Do families want to be present duringCPR? 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 Nurs1992;18:104–6.418. Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, Egleston CV, Prevost AT.Psychological effect of witnessed resuscitation on bereaved relatives. Lancet1998;352:614–7.419. Compton S, Madgy A, Goldstein M, et al. Emergency medical service providers’experience with family presence during cardiopulmonary resuscitation. Resuscitation2006;70:223–8.420. Beckman AW, Sloan BK, Moore GP, et al. Should parents be present duringemergency department procedures on children, and who should make thatdecision? A survey of emergency physician and nurse attitudes. Acad EmergMed 2002;9:154–8.421. Eppich WJ, Arnold LD. Family member presence in the pediatric emergencydepartment. Curr Opin Pediatr 2003;15:294–8.422. Eichhorn DJ, Meyers TA, Mitchell TG, Guzzetta CE. Opening the doors: familypresence during resuscitation. J Cardiovasc Nurs 1996;10:59–70.423. Jarvis AS. Parental presence during resuscitation: attitudes of staff on a paediatricintensive care unit. Intensive Crit Care Nurs 1998;14:3–7.www.elsuapdetodos.com
Resuscitation 81 (2010) 1389–139918 de 0ctubre de 2010 www.elsuapdetodos.comContents lists available at ScienceDirectResuscitationjournal homepage: www.elsevier.com/locate/resuscitationEuropean Resuscitation Council Guidelines for Resuscitation 2010Section 7. Resuscitation of babies at birthSam Richmond a,1 , Jonathan Wyllie b,∗,1a Neonatology, Sunderland Royal Hospital, Sunderland, UKb Neonatology and Paediatrics, The James Cook University Hospital, Middlesbrough, UKIntroductionThe following guidelines for resuscitation at birth have beendeveloped during the process that culminated in the 2010 InternationalConsensus Conference on Emergency Cardiovascular Care(ECC) and Cardiopulmonary Resuscitation (CPR) Science withTreatment Recommendations. 1,2 They are an extension of theguidelines already published by the ERC 3 and take into accountrecommendations made by other national and international organisations.Summary of changes since 2005 GuidelinesThe following are the main changes that have been made to theguidelines for resuscitation at birth in 2010:• For uncompromised babies, a delay in cord clamping of at least1 min from the complete delivery of the infant, is now recommended.As yet there is insufficient evidence to recommend anappropriate time for clamping the cord in babies who are severelycompromised at birth.• For term infants, air should be used for resuscitation at birth.If, despite effective ventilation, oxygenation (ideally guided byoximetry) remains unacceptable, use of a higher concentrationof oxygen should be considered.• Preterm babies less than 32 weeks gestation may not reachthe same arterial blood oxygen saturations in air as thoseachieved by term babies. Therefore blended oxygen and airshould be given judiciously and its use guided by pulse oximetry.If a blend of oxygen and air is not available use what isavailable.• Preterm babies of less than 28 weeks gestation should be completelycovered in a food-grade plastic wrap or bag up to theirnecks, without drying, immediately after birth. They should thenbe 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 afteradmission. For these infants delivery room temperatures shouldbe at least 26 ◦ C.• The recommended compression:ventilation ratio for CPR remainsat 3:1 for newborn resuscitation.• Attempts to aspirate meconium from the nose and mouth ofthe unborn baby, while the head is still on the perineum, arenot recommended. If presented with a floppy, apnoeic babyborn through meconium it is reasonable to rapidly inspect theoropharynx to remove potential obstructions. If appropriateexpertise is available, tracheal intubation and suction may beuseful. However, if attempted intubation is prolonged or unsuccessful,start mask ventilation, particularly if there is persistentbradycardia.• If adrenaline (epinephrine) is given then the intravenous route isrecommended using a dose of 10–30 gkg −1 . If the tracheal routeis used, it is likely that a dose of at least 50–100 gkg −1 will beneeded to achieve a similar effect to 10 gkg −1 intravenously.• Detection of exhaled carbon dioxide in addition to clinical assessmentis recommended as the most reliable method to confirmplacement of a tracheal tube in neonates with spontaneous circulation.• Newly born infants born at term or near-term with evolving moderateto severe hypoxic–ischemic encephalopathy should, wherepossible, be offered therapeutic hypothermia. This does not affectimmediate resuscitation but is important for post-resuscitationcare.www.elsuapdetodos.comThe guidelines that follow do not define the only way that resuscitationat birth should be achieved; they merely represent a widelyaccepted view of how resuscitation at birth can be carried out bothsafely and effectively (Fig. 7.1).Preparation0300-9572/$ – see front matter © 2010 European Resuscitation Council. Published by Elsevier Ireland Ltd. All rights reserved.doi:10.1016/j.resuscitation.2010.08.018Relatively few babies need any resuscitation at birth. Of thosethat do need help, the overwhelming majority will require onlyassisted lung aeration. A small minority may need a brief period ofchest compressions in addition to lung aeration. Of 100,000 babiesborn in Sweden in 1 year, only 10 per 1000 (1%) babies of 2.5 kg ormore appeared to need resuscitation at delivery. 4 Of those babies
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