Cardiopulmonary Resuscitation
1. Perform hand washing.
2. Don gloves.
3. Prepare all necessary equipment needed during CPR:
a. e-kit
b. intubation set
c. pair of surgical gloves
d. suction machine
e. resuscitation bag with neonatal face mask
f. oxygen supply (oxygen tank)
4. Position of the infant and removal of secretions as needed Secretions should be cleared first from the mouth and then from the nose Neutral or slightly extended position by placing a towel under the infant's shoulders.
5. Routine drying and suctioning Alternative methods: rubbing the back flicking the soles of the feet If no response to tactile stimulation occurs within few seconds: Bag and mask ventilation with 100% oxygen.
6. If the heart rate is less than 60 bpm, chest compressions must be started while continuing assisted ventilation Progress to endotracheal intubation should be considered Bag and Mask Ventilation.
7. Indications for endotracheal intubation may occur at several points during neonatal resuscitation: Tracheal suctioning for meconium (depressed baby) BMV ineffective or prolonged Chest compressions needed Tracheal administration of medications Congenital diaphragmatic hernia Extreme prematurity Transport Endotracheal intubation.
8. A straight blade should be used (size 0 for premature infants, size 1 for term infants) An estimate for the correct oral insertion distance of the ET tube use the following formula: Endotracheal intubation Weight in kilograms + 6 cm = insertion depth at lip in cm.
9. After the procedure, check successful intubation and correct positioning of the ET tube by the following: Normal and symmetric chest wall movements Equal breath sounds (axillae) Absence of breath sounds or distension over the stomach Condensation in the tube during exhalation Improvement in heart rate, colour and spontaneous respirations Exhaled-CO 2 monitor Endotracheal intubation.
10. If the heart rate is less than 60 bpm despite 30 seconds of effective positive pressure ventilation with 100% oxygen: Chest compressions Start chest compressions.
11. Chest compressions performed in conjunction with ventilation with 100% oxygen (3 to 1 ratio 90 compressions and 30 breaths per minute) Chest compressions.
12. If heart rate is less than 60 bpm after 30 seconds of adequate ventilation and chest compressions, or in the presence of asystole Emergency drugs and fluids Adrenaline.
13. Adrenaline Dose (I.V., ET or I.O.): 0.1 to 0.3 mL/kg of a 1:10.000 solution (0.01 to 0.03 mg/kg) repeat every 3 to 5 minutes as indicated Emergency drugs and fluids.
14. Respiratory activity Heart rate Colour Breathing Heart rate > 100 Pink Continue evaluation Standard care Apnoea or gasping Heart rate < 100 Positive pressure ventilation (*) Oxygen.
15. Ventilating Heart rate > 100 Pink Ongoing support Positive pressure ventilation and oxygen Heart rate < 60 Positive pressure ventilation (*) Chest compressions.
16. Heart rate > 60 Positive pressure ventilation (*) Oxygen Positive pressure ventilation and chest compressions Heart rate < 60 Adrenaline (*) (via intravenous, endotracheal, intraosseus).
17. When the newborn is stable after a CPR, conduct a close monitoring.
18. Do aftercare.
19. Document properly.
20. Perform Hand washing.
2. Don gloves.
3. Prepare all necessary equipment needed during CPR:
a. e-kit
b. intubation set
c. pair of surgical gloves
d. suction machine
e. resuscitation bag with neonatal face mask
f. oxygen supply (oxygen tank)
4. Position of the infant and removal of secretions as needed Secretions should be cleared first from the mouth and then from the nose Neutral or slightly extended position by placing a towel under the infant's shoulders.
5. Routine drying and suctioning Alternative methods: rubbing the back flicking the soles of the feet If no response to tactile stimulation occurs within few seconds: Bag and mask ventilation with 100% oxygen.
6. If the heart rate is less than 60 bpm, chest compressions must be started while continuing assisted ventilation Progress to endotracheal intubation should be considered Bag and Mask Ventilation.
7. Indications for endotracheal intubation may occur at several points during neonatal resuscitation: Tracheal suctioning for meconium (depressed baby) BMV ineffective or prolonged Chest compressions needed Tracheal administration of medications Congenital diaphragmatic hernia Extreme prematurity Transport Endotracheal intubation.
8. A straight blade should be used (size 0 for premature infants, size 1 for term infants) An estimate for the correct oral insertion distance of the ET tube use the following formula: Endotracheal intubation Weight in kilograms + 6 cm = insertion depth at lip in cm.
9. After the procedure, check successful intubation and correct positioning of the ET tube by the following: Normal and symmetric chest wall movements Equal breath sounds (axillae) Absence of breath sounds or distension over the stomach Condensation in the tube during exhalation Improvement in heart rate, colour and spontaneous respirations Exhaled-CO 2 monitor Endotracheal intubation.
10. If the heart rate is less than 60 bpm despite 30 seconds of effective positive pressure ventilation with 100% oxygen: Chest compressions Start chest compressions.
11. Chest compressions performed in conjunction with ventilation with 100% oxygen (3 to 1 ratio 90 compressions and 30 breaths per minute) Chest compressions.
12. If heart rate is less than 60 bpm after 30 seconds of adequate ventilation and chest compressions, or in the presence of asystole Emergency drugs and fluids Adrenaline.
13. Adrenaline Dose (I.V., ET or I.O.): 0.1 to 0.3 mL/kg of a 1:10.000 solution (0.01 to 0.03 mg/kg) repeat every 3 to 5 minutes as indicated Emergency drugs and fluids.
14. Respiratory activity Heart rate Colour Breathing Heart rate > 100 Pink Continue evaluation Standard care Apnoea or gasping Heart rate < 100 Positive pressure ventilation (*) Oxygen.
15. Ventilating Heart rate > 100 Pink Ongoing support Positive pressure ventilation and oxygen Heart rate < 60 Positive pressure ventilation (*) Chest compressions.
16. Heart rate > 60 Positive pressure ventilation (*) Oxygen Positive pressure ventilation and chest compressions Heart rate < 60 Adrenaline (*) (via intravenous, endotracheal, intraosseus).
17. When the newborn is stable after a CPR, conduct a close monitoring.
18. Do aftercare.
19. Document properly.
20. Perform Hand washing.