Cardiac resuscitation of the newborn infant

Cardiac resuscitation of the newborn infant Report

of a case

PAUL

D.

RAHTER,

JAMES

R.

Camden,

New

HERRON,

gency.

With

contractions and

death

occurs,

is an

the

stasis

of

the

obstetrical

of

delivery,

fetal

chest

emerthe

by

results

in

cardiac

arrest

infant.l

If

cardiac

arrest

resuscitation

may

if

resuscitation

team

and

severe

the

successful the

use of an intermittent positive pressure breathing type resuscitator, the lungs were rapidly expanded several times. There was no improvement in the condition of the infant. An incision was then made over the left fifth intercostal space anteriorly and extended until the heart could be palpated. The heart was in arrest, and immediate rhythmic compression M:as

uterine

often of

achieved swiftly

M.D

Jersey

s II o u L I) E R dystocia compression

M.D.

still

be

works

vigorously.

begun. At the same time, the intermittent rhythmic expansion of the lungs with oxygen was cnntinued. As the oxygenated blood was circulated by thr rhythmic massage of the heart, improvement in the color of the infant’s skin, lips, and nail beds

The mother was a 32-year-old gravida iii, para ii, who had had 2 previous normal vaginal deliveries. Present prenatal course and early labor w
was

noted. This resuscitation was continued for 3 minutes with no spontaneous cardiac action. Therefore, 0.5 C.C. of l:l,OOO epinephrine was injected into the myocardium. This produced an improvement in the tone of the heart, which had been flaccid, but no return of spontaneous cardiac action. After another 2 minutes of resuscitation, another 0.5 CL of 1: 1,000 epinephrine was injected into the myocardium. The heart began to beat spontaneously. As the beat became stronger, the

posterior to the left occipitoanterior position after several uterine contractions, and the head was delivered without difficulty after a small episiotomy was made. Immediate difficulty was noted when an attempt was made to proceed with the delivery of the shoulders. As vigorous efforts at extraction were made, the infant remained thus, with head delivered and anterior shoulder impinged against the symphysis pubis, for 2 to 3 minutes. The infant made several gasping efforts during this time. With maneuvering, the posterior shoulder of the infant was rotated 180 degrees anteriorly,

assisting massage was discontinued. The chest was closed with underwater seal drainage. The stomach was emptied and secretions were removed from the tracheobronchial tree. At this time respiration was spontaneous and adequatr. The infant was transferred to an incubator in the nursery. He was crying and moving all extremities. His postoperative course was excellent and he was discharged 24 days after birth. The haby is now 7 months old and appear% to be a normal, healthy youngster.

allowing the shoulder which had been anterior and impinged to enter the pelvis in the posterior segment. The delivery was then rapidly completed. It was apparent that the condition of the infant was critical and the obstetrician immediately notrd that no heartbeat could be felt. By

Summary From the Departments and Obstetrics, Our Hospital.

of Anesthesia Lady of Lourdes

A of 249

case

a newborn

and of

conclusions

successful infant

cardiac is reported.

resuscitation It

appears

250

Rahter and Herron

that the principles of cardiac resuscitation which have hren singularly successful in the treatment of cardiac arrest in the adult arc equally applicable to the newborn infant. It is possible that some of the fetal deaths associated with shoulclct~ dystocia may 1,~

due to reflex cardiac arrest? frequent cardiac resusitation

and that more may save lives.

REFERENCE

I.

Schwartz, Pr Gynec.

R. Cl., and Dixon. 11: 468, 1958.

D.

M.:

Obst.