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Suboptimal heart rate assessment and airway management in infants receiving delivery room chest compressions: a quality assurance project
  1. Anne Marthe Boldingh1,
  2. Christiane Skåre2,3,
  3. Britt Nakstad1,
  4. Anne Lee Solevåg1
  1. 1 Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway
  2. 2 Department of Anaesthesiology, Oslo University Hospital Ullevaal, Oslo, Norway
  3. 3 Norwegian National Advisory Unit for Prehospital Emergency Care (NAKOS), Oslo University Hospital Ullevaal, Oslo, Norway
  1. Correspondence to Dr Anne Lee Solevåg, The Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lorenskog 1478, Norway; a.l.solevag{at}medisin.uio.no

Abstract

Objective In a previous audit, we demonstrated poor compliance with the neonatal resuscitation algorithm. Training can improve guideline compliance and performance. We aimed to prospectively collect detailed data on delivery room resuscitations to identify needs for educational interventions.

Design Observational study using video recordings of neonatal resuscitations. We analysed episodes where chest compressions (CCs) were provided.

Setting A Norwegian university hospital.

Patients All delivery room resuscitations August 2014 to November 2016.

Interventions The recordings were transcribed using Interact V.9 software (Mangold Int GmbH, Arnstorf, Germany). Supplementary information was collected from the patient electronic records.

Main outcome measures Heart rate (HR) assessment, provision of positive pressure ventilation (PPV) and CC, endotracheal intubation and team communication.

Results Twenty-nine CC episodes were analysed. We identified team discordance in the decisions to perform CC and only 6 (21%) were retrospectively judged to be in need for CC: 8 (28%) infants had adequate spontaneous respiration, 18 (62%) infants received ineffective PPV and 5 (17%) had a HR >60 bpm. Only one infant was intubated before CC, and we could not identify a consistent pattern of ventilation corrective actions. One infant received CC without prior HR assessment. In some infants, CC duration was exceedingly short, and 11 (38%) of the infants that received CC were not admitted to the NICU. Six (21%) infants had no documentation of CPR in the delivery record.

Conclusions Education and training should focus on team function and communication, correct and timely HR assessment, effective PPV, and indications for endotracheal intubation.

  • neonatology
  • resuscitation
  • medical education
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Footnotes

  • Contributors AMB: conceptualised and designed the study, performed the data collection, was involved in the data analysis and data interpretation, wrote the manuscript and approved the final manuscript as submitted. CS: conceptualised and designed the study, was involved in the data collection, analysis and data interpretation, critically reviewed the manuscript and approved the final manuscript as submitted. BN: conceptualised and designed the study, was involved in the data collection, analysis and data interpretation, critically reviewed the manuscript and approved the final manuscript as submitted. ALS: conceptualised and designed the study, performed the data analysis and data interpretation, wrote the manuscript and approved the final manuscript as submitted.

  • Funding The study was supported by grants from the Laerdal Foundation for Acute Medicine.

  • Disclaimer The study sponsor had no involvement in the study design, in the collection, analysis, interpretation of data or in writing of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Ethics approval The institutional review board at AUH approved presumed consent from the parents (ID number 14-032).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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