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Cardiac arrest with pulseless electrical activity rhythm in newborn infants: a case series
  1. Deandra Luong1,
  2. Po-Yin Cheung1,
  3. Keith J Barrington2,
  4. Peter G Davis3,
  5. Jennifer Unrau4,
  6. Shyamala Dakshinamurti5,
  7. Georg M Schmölzer6
  1. 1 Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  2. 2 Department of Neonatology, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada
  3. 3 Newborn Research, The Royal Women’s Hospital, Melbourne, Victoria, Australia
  4. 4 Department of Neonatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  5. 5 University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
  6. 6 Department of Neonatology, Royal Alexandra Hospital, Edmonoton, Alberta, Canada
  1. Correspondence to Dr Georg M Schmölzer, Neonatology, Royal Alexandra Hospital, Edmonoton AB T5H 3V9, Canada; georg.schmoelzer{at}


The 2015 neonatal resuscitation guidelines added ECG to assess an infant’s heart rate when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room. We report four cases of pulseless electrical activity during neonatal cardiopulmonary resuscitation in levels II–III neonatal intensive care units in Canada (Edmonton [n=3] and Winnipeg [n=1]).

Healthcare providers should be aware that pulseless electrical activity can occur in newborn infants during cardiopulmonary resuscitation. We propose an adapted neonatal resuscitation algorithm to include pulseless electrical activity. Furthermore, in compromised newborns, heart rate should be assessed using a combination of methods/techniques to ensure accurate heart rate assessment. When ECG displays a heart rate but the infant is unresponsive, pulseless electrical activity should be suspected and chest compression should be started.

  • infants
  • newborn
  • neonatal resuscitation
  • asphyxia
  • pulseless electrical activity
  • cardiac arrest

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  • Contributors Conception and design: all authors. Collection and assembly of data: all authors. Analysis and interpretation of the data: all authors. Drafting of the article: all authors. Critical revision of the article for important intellectual content: GMS, P-YC, SD, JU, KJB, DL. Final approval of the article: all authors.

  • Funding GMS is a recipient of the Heart and Stroke Foundation/University of Alberta Professorship of Neonatal Resuscitation, a National New Investigator of the Heart and Stroke Foundation Canada and an Alberta New Investigator of the Heart and Stroke Foundation Alberta. PGD is supported by an NHMRC Practitioner Fellowship #1059111. This research has been facilitated by the Women and Children’s Health Research Institute through the generous support of the Stollery Children’s Hospital Foundation.

  • Competing interests None declared.

  • Ethics approval The ethics advisory committees at the University of Alberta in Edmonton and Manitoba in Winnipeg approved the publication of the information.

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

  • Patient consent for publication Not required.