Resuscitation Council (UK)

Frequently asked questions

Newborn life support

In the majority of babies born with a slow heart rate, this will usually increase within the 30–60 seconds it takes to complete five effective inflation breaths and 30 seconds of effective ventilation breaths. It is therefore, logical to start compressions only if the heart rate remains less than 60 min-1 after this period of 30 seconds of effective ventilation. This hopefully clarifies previous confusion.
 
This change to the guidelines means that lung expansion and ventilation is established. There is more opportunity for the heart rate to respond which usually occurs within 30 seconds of effective ventilation and avoids the potential compromise of ventilation by compressions.
 
If the heart rate remains below 60 min-1 or absent after this period, synchronized compressions should be commenced at 3 compressions:1 ventilation before reassessing heart rate.
 
The heart rate should be reassessed every 30 seconds and once the heart rate exceeds 60 min-1 the compressions should be stopped.

In the rare cases where there is an undetectable heart rate and the resuscitator is certain they have seen chest movement through the 5 inflation breaths, it is acceptable for the resuscitator to start 3:1 ventilations to compressions immediately though this remains a professional judgement. 30 seconds of ventilation breaths prior to starting compressions in any circumstances will optimise lung aeration and thus ensure subsequent compressions have best chance of working. In practice, when auscultating the heart rate after five inflation breaths when two resuscitators are present, ventilation breaths are usually continued as a matter of course during this period.

Effective inflation breaths and ventilation will help the majority of babies, it is therefore essential to ensure that this has occurred before instituting compressions. Compressions without effective ventilation are ineffective and may even impede ventilation.

The NLS guidelines are specifically intended for resuscitation at birth. They deal with warming and drying and assessment of the newborn followed, if necessary, by resuscitation, which is mainly concerned with the initial inflation of the lungs and establishing stable respiration. This is different to resuscitation at any other time of life. In addition, the questions of oxygen administration, airway blockage, meconium aspiration and umbilical venous catheterisation are considered which are also usually only applicable to babies in the first hours of life.

The major difference between newborn guidelines and paediatric is in the ratio of compressions to ventilations in CPR. The ILCOR evaluation of the evidence for these two groups arrived at different conclusions. Newborn babies and those on medical neonatal units, special care units and postnatal wards should usually receive 3 compressions to 1 ventilation as the reason for resuscitation is most likely to be respiratory and this ratio is most likely to deliver an appropriate ventilation rate. If a baby is thought to have a primary cardiac cause for arrest consideration should be given to 15 compressions to 2 ventilations.

A baby who has successfully adapted to extra uterine life and has subsequently collapsed and presented to A&E, or collapsed on a joint Neonatal/Paediatric medical and surgical intensive care unit should be resuscitated according to paediatric life support algorithms with a 15:2 compression to ventilation ratio.

May 2015

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