Chest compressions and medications during neonatal resuscitation

Prolonged resuscitation in neonates, although quite rare, may occur in response to pro-found intractable bradycardia as a result of asphyxia. In these instances, chest compres-sions and medications may be necessary to facilitate return of spontaneous circulation. While performing chest compressions, the two thumb method is preferred over the two fin-ger technique, although several newer approaches are under investigation. While the ideal compression to ventilation ratio is still uncertain, a 3:1 ratio remains the recommendation by the Neonatal Resuscitation Program. Use of feedback mechanisms to optimize neonatal cardiopulmonary resuscitation (CPR) show promise and are currently under investigation. While performing optimal cardiac compressions to pump blood, use of medications to restore spontaneous circulation will likely be necessary. Current recommendations are that epinephrine, an endogenous catecholamine be used preferably intravenously or by intraosseous route, with the dose repeated every 3-5 minutes until return of spontaneous circulation. Finally, while the need for volume replacement is rare, it may be considered in instances of acute blood loss or poor response to resuscitation.(c) 2022 Published by Elsevier Inc.

Automated summary

Prolonged resuscitation in neonates is rare but may occur as a result of severe bradycardia due to asphyxia. Chest compressions and medications are necessary for spontaneous circulation return. The two thumb method is preferred for chest compressions. The ideal compression to ventilation ratio is still uncertain, but the recommended ratio is 3:1. The use of feedback mechanisms for optimal neonatal CPR is promising and currently under investigation. Medications, such as epinephrine, may be required to restore spontaneous circulation. In rare cases, volume replacement may be considered.