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Which method of chest compression should be used when resuscitating a newborn?

Published:February 03, 2018DOI:https://doi.org/10.1016/j.ajem.2018.01.086
      About 10% of newborns need assistance to establish effective ventilation [
      • Perlman J.M.
      • Wyllie J.P.
      • Kattwinkel J.
      • Wyckoff M.H.
      • Aziz K.
      • Guinsburg R.
      • et al.
      Part 7: neonatal resuscitation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.
      ] which remains the most critical step of neonatal resuscitation. Fortunately, the need for chest compressions in the delivery room is rare. Approximately 0.1% of term newborns and 15% of preterm newborns require chest compression at birth due to birth asphyxia [
      • Shah P.S.
      Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a systematic review and meta-analyses.
      ]. High quality chest compressions improve cerebral and myocardial perfusion. While the medical staff performs cardiopulmonary resuscitation in adult patients almost routinely, there is a general fear of cardiopulmonary resuscitation in children and newborns. American Heart Association guidelines recommend that in the case of a single person resuscitation of the newborn it should be carried out using the technique of two fingers and when performed by two people the method of two thumbs should be the preferred method [
      • Wyckoff M.H.
      • Aziz K.
      • Escobedo M.B.
      • Kapadia V.S.
      • Kattwinkel J.
      • Perlman J.M.
      • et al.
      Part 13: neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
      ]. Numerous authors proposed various modifications of the two-finger method. Recently the article “A randomized comparison of three chest compression techniques and the associated hemodynamic effect during infant CPR: A randomized manikin study” was published in the American Journal of Emergency Medicine [
      • Smereka J.
      • Szarpak L.
      • Rodríguez-Núñez A.
      • Ladny J.R.
      • Leung S.
      • Ruetzler K.
      A randomized comparison of three chest compression techniques and associated hemodynamic effect during infant CPR: a randomized manikin study.
      ], in which the authors describe an innovative method of chest compressions in infants and then compare it with currently recommended two other methods. This study was also extended by a group of newborns immediately after birth, who were simulated by the most advanced simulator in the world [
      • Smereka J.
      • Kaminska H.
      • Wieczorek W.
      • Dabrowski M.
      • Ladny J.R.
      • Ruetzler K.
      • et al.
      Which position should we take during newborn resuscitation? A prospective, randomized, multicentre simulation trial.
      ]. The results obtained by Smereka indicate that the chest compression method proposed by him may become a staple method in the guidelines for cardiopulmonary resuscitation of infants and newborns. Obviously, studies conducted by Smereka [
      • Smereka J.
      • Szarpak L.
      • Rodríguez-Núñez A.
      • Ladny J.R.
      • Leung S.
      • Ruetzler K.
      A randomized comparison of three chest compression techniques and associated hemodynamic effect during infant CPR: a randomized manikin study.
      ,
      • Smereka J.
      • Kaminska H.
      • Wieczorek W.
      • Dabrowski M.
      • Ladny J.R.
      • Ruetzler K.
      • et al.
      Which position should we take during newborn resuscitation? A prospective, randomized, multicentre simulation trial.
      ,
      • Smereka J.
      • Kasiński M.
      • Smereka A.
      • Ładny J.R.
      • Szarpak Ł.
      The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover manikin trial.
      ,
      • Smereka J.
      • Szarpak L.
      • Smereka A.
      • Leung S.
      • Ruetzler K.
      Evaluation of new two-thumb chest compression technique for infant CPR performed by novice physicians. A randomized, crossover, manikin trial.
      ] are simulation studies which require transfer to real patients, however the results are promising. Therefore, further studies are necessary to develop new techniques of optimizing the quality of the chest compression in each age group.
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