出生后在分娩室(DR)进行心肺复苏(CPR)很少见。我们假设与母亲有关的因素,delivery,可以确定与结局相关的婴儿和复苏事件特征.我们还假设新生儿复苏计划(NRP)算法会有很大差异。
从2001年至2014年,对AHAGetWithTheGuidelines-Resuscitation注册表中所有接受DR胸部按压的新生儿进行回顾性审查。主要结果是DR中自发循环(ROSC)的恢复。次要结果是生存至出院。使用描述性统计来表征数据。计算具有置信区间的赔率比,以比较幸存者和非幸存者。
有1153名新生儿在DR中接受胸部按压。968例(84%)新生儿实现了ROSC,761例(66%)存活出院。51%的队列在没有药物的情况下接受了胸部按压。76%的事件在生命的第一分钟内开始心脏按压,在气管插管前发生了79%的事件。在单变量分析中,诸如早产等因素,尝试气管内插管的次数,增加第一次肾上腺素剂量的时间,CPR持续时间与DR中ROSC几率降低相关。在多变量分析中,较长的CPR持续时间与ROSC几率降低相关。
在分娩后接受胸部按压的婴儿队列中,确定了可识别的出生前风险因素以及与实现ROSC的几率增加和降低相关的复苏干预措施.胸部按压通常在事件的第一分钟开始,并且通常在气管内插管之前开始。进一步的调查应侧重于减少关键复苏干预时间的方法。如成功的气管插管和第一剂肾上腺素的给药,以改善DR-CPR结果。
Cardiopulmonary resuscitation (CPR) in the delivery room (DR) after birth is rare. We hypothesized that factors related to maternal, delivery, infant and resuscitation event characteristics associated with outcomes could be identified. We also hypothesized there would be substantial variation from the Neonatal Resuscitation Program (NRP) algorithm.
Retrospective review of all neonates receiving chest compressions in the DR from the AHA Get With The Guidelines-Resuscitation registry from 2001 to 2014. The primary outcome was return of spontaneous circulation (ROSC) in the DR. Secondary outcome was survival to hospital discharge. Descriptive statistics were used to characterize data. Odds ratios with confidence intervals were calculated as appropriate to compare survivors and non-survivors.
There were 1153 neonates who received chest compressions in the DR. ROSC was achieved in 968 (84%) newborns and 761 (66%) survived to hospital discharge. Fifty-one percent of the cohort received chest compressions without medications. Cardiac compressions were initiated within the first minute of life in 76% of the events, and prior to endotracheal intubation in 79% of the events. In univariate analysis, factors such as prematurity, number of endotracheal intubation attempts, increased time to first adrenaline dose, and CPR duration were associated with decreased odds of ROSC in the DR. Longer CPR duration was associated with decreased odds of ROSC in multivariate analysis.
In this cohort of infants receiving chest compressions following delivery, recognizable pre-birth risk factors as well as resuscitation interventions associated with increased and decreased odds of achieving ROSC were identified. Chest compressions were frequently initiated in the first minute of the event and often prior to endotracheal intubation. Further investigations should focus on methods to decrease time to critical resuscitation interventions, such as successful endotracheal intubation and administration of the first dose of adrenaline, in order to improve DR-CPR outcomes.