Sir,
The review article published in your recent issue on the update on neonatal perioperative resuscitation is very informative and well-written.[1] The guidelines indeed provide a roadmap for neonatal rescue and resuscitation particularly in centers devoid of dedicated neonatal anesthesiologists.
However, we were drawn to the mentioned rate of ventilation with an advanced airway as, 1 breath in 6 seconds, in Figure 2 of the intraoperative cardiac arrest algorithm.[1]
The neonatal resuscitation algorithm by the 2020 American Heart Association (AHA) guidelines on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) qualifies positive pressure ventilation (PPV) as the cornerstone for neonatal resuscitation, where PPV is delivered at 40–60 breaths per minute with an inspiratory time 1 second or less in all “ newly borns” (from birth to the end of resuscitation and stabilization) at a peak inflation pressure of 30 cm in term and 20–25 preterms.[1] Further, neonatal resuscitation applies to all newly borns and neonates during the first hospitalization after birth. The adequacy of ventilation in these scenarios is determined by a rise in heart rate over the presence of visible chest rise.[2]
Pediatric basic and advanced life support guidelines by the 2020 AHA guidelines on CPR and ECC recommend the assisted ventilation rates as 1 breath every 2–3 seconds irrespective of the employed ventilation strategy during resuscitation (advanced or native airway).[3] These revised ventilation rates were updated to avoid ambiguity and lend uniformity across all scenarios. The guidelines apply to age groups extending from neonates after hospital discharge till the age of puberty. These updated recommendations are based on data showing improved rates of return of spontaneous circulation (ROSC) and survival in in-hospital cardiac arrests (IHCA).[3] This is a major change made in 2020 AHA guidelines on neonatal resuscitation in order to simplify care.
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References
- 1.Jafra A, Jain D, Bhardwaj N, Yaddanapudi S. Neonatal perioperative resuscitation (NePOR) protocol-An update. Saudi J Anaesth. 2023;17:205–13. doi: 10.4103/sja.sja_632_22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Aziz K, Lee HC, Escobedo MB, Hoover AV, Kamath-Rayne BD, Kapadia VS, et al. Part 5: Neonatal resuscitation: 2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_Suppl_2):S524–50. doi: 10.1161/CIR.0000000000000902. doi: 10.1161/CIR.0000000000000902. [DOI] [PubMed] [Google Scholar]
- 3.Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL, Jr, et al. Part 4: Pediatric basic and advanced life support: 2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_Suppl_2):S469–523. doi: 10.1161/CIR.0000000000000901. doi: 10.1161/CIR.0000000000000901. [DOI] [PubMed] [Google Scholar]