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The impact of neonatal resuscitation program courses on outcomes of newborns with perinatal asphyxia in Lithuania
Abstracts / Resuscitation 81S (2010) S1–S114 AP170 Comparing methods for weight estimation of children: A preliminary study Lulic I. 1 , Kovic I. 2 1 Ambulance 2
Service Rijeka, Rijeka, Croatia Ambulance Service Pazin, Pazin, Croatia
Purpose of the study: In paediatric emergencies it is vital to promptly and accurately estimate children’s weight. Child’s weight is used to calculate drug dosages, equipment sizes and energy of defibrillation shock. Our goal was to evaluate the methods for weight estimation of children in our region. Materials and methods: All children aged 0–14 years, who visited clinics of Ambulance Service Rijeka and Pazin in the period of 3 months, during working hours of the authors, were included in the study. A total of 209 children presenting with acute illnesses, excluding life-threatening conditions, had their weight and height measured. Furthermore, their weight was estimated according to methods based on age (formulas: EPLS1 , Argall2 , Best Guess3 , Luscombe and Owens4 ) and length (Broselow tape5 ). Accuracy of methods was defined as agreement within 10% between the actual and estimated weights. Results: Tables 1 and 2.
EPLS Argall Best Guess Luscombe&Owens
paired resuscitators at set pressures for NP and set parameters for SIB. Airway pressure, flow, inspiratory tidal volume, expiratory tidal volume and mask leak were recorded. Results: A total of 21 578 inflations were recorded and analysed. For SIB, mask leak was greater (11.5%) with single-person compared to two-person (5.4%; mean difference 6.1%, 95% CI 1.5–10.7, p < 0.01). For NP, mask leak was greater for single-person (22.2%) compared to two-person (9.1%; mean difference 13.1% 95% CI 3.6–22.6, p < 0.01). For single-person mask ventilation, mask leak was greater with NP (22.2%) compared to SIB (11.5%; mean difference 10.7%, 95% CI 1.4–19.7, p < 0.01). For two-person mask ventilation, mask leak was greater for NP (9.1%) compared to SIB (5.4%; mean difference 3.7%, 95% CI 0.1–6.4, p < 0.05). Conclusions: Two-person mask ventilation technique reduces mask leak by approximately 50% compared to the standard one-person mask ventilation method. NP mask ventilation has higher mask leak than Laerdal SIB for both single- and two-person technique mask ventilation. doi:10.1016/j.resuscitation.2010.09.316 AP172 Ventilator-delivered mask ventilation compared with three standard methods of mask ventilation in a manikin model
Table 1 Age based. Formula
S77
Age (years)
1–10 1–10 0–14 1–10
Total number of children
Number of children accurately estimated
156 156 209 156
Percentage of children accurately estimated (%)
56 72 96 72
36 46 46 46
Table 2 Length based. Method
Length (centimeters)
Total number of children
Number of children accurately estimated
Percentage of children accurately estimated (%)
Broselow tape
46–145
151
88
58
Conclusions: Broselow tape was the most accurate method for weight estimation of children in our study. In majority of cases when it was wrong, it slightly underestimated children’s weight. This could be less dangerous than larger mistakes made by formulas based on age. The most widely used formula in our region, the EPLS formula, demonstrated the poorest estimation accuracy. Our study will continue to include a larger sample of children from different parts of Croatia, and with in-depth analyses of the results, offer recommendations to our medical workers.
Tracy M.B. 1,3 , Klimek J. 1,3 , Coughtrey H. 1,3 , Shingde V. 1,3 , Ponnampalam G. 1 , Hinder M. 1 , Maheshwari R. 1 , Tracy S.K. 2,3 1 Westmead 2 3
Hospital Sydney West Area Health Service, Sydney, Australia Royal Hospital for Women, Sydney, Australia University of Sydney, Sydney, Australia
Purpose: Little is known regarding the variations in effective ventilation during bag and mask resuscitation with standard methods compared with that delivered by ventilator-delivered mask ventilation (VDMV). The aim was to measure the variations in delivered airway pressure, tidal volume (TV), minute ventilation (MV) and inspiratory time during a 3-min period of mask ventilation comparing VDMV with three commonly used hand delivered methods of bag and mask ventilation: Laerdal self-inflating bag (SIB); anaesthetic bag and T-piece Neopuff. Material and methods: A modified resuscitation manikin was used to measure variation in mechanical ventilation during 3-min periods of mask ventilation. Thirty-six experienced practitioners gave positive pressure mask ventilation targeting acceptable chest wall movement with a rate of 60 inflations/min and when pressures could be targeted or set, a peak inspiratory pressure (PIP) of 18 cm water, positive end-expiratory pressure (PEEP) of 5 cm water, for 3 min with each of the four mask ventilation methods. Each mode was randomly sequenced. Results: A total of 21,136 inflations were recorded and analysed. VDMV achieved PIP and PEEP closest to that targeted and significantly lower variation in all measured parameters (p < 0.001) other than with PIP. SIB delivered TV and MV over twice that delivered by VDMV and Neopuff. Conclusion: During 3-min periods of mask ventilation on a manikin, VDMV produced the least variation in delivered ventilation. SIB produced wide variation and unacceptably high TV and MV in experienced hands.
References doi:10.1016/j.resuscitation.2010.09.317 1. European Resuscitation Council. European Paediatric Life Support (EPLS) manual. London: Resuscitation Council (UK); 2006. 2. Argall JA, Wright N, Mackway-Jones K, Jackson R. A comparison of two commonly used methods of weight estimation. Arch Dis Child 2003;88:789–90. 3. Tinning K, Acworth J. Make your Best Guess: an updated method for paediatric weight estimation in emergencies. Emerg Med Aust 2007;19:528–34. 4. Luscombe M, Owens B. Weight estimation in resuscitation: is the current formula still valid? Arch Dis Child 2007;92:412–5. 5. Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell F,W. A rapid method for estimating weight and resuscitation drug dosages from length in the pediatric age group. Ann Emerg Med 1998;17:576–1781. doi:10.1016/j.resuscitation.2010.09.315
Newborn Life Support AP171 Mask leak in one-person mask ventilation compared to two-person in newborn infant manikin study Tracy M.B. 1,3 , Klimek J. 1,3 , Coughtrey H. 1,3 , Shingde V. 1,3 , Ponnampalam G. 1 , Hinder M. 1 , Maheshwari R. 1 , Tracy S.K. 2,3 1 Westmead 2 3
Hospital Sydney West Area Health Service, Sydney, Australia Royal Hospital for Women, Sydney, Australia University of Sydney, Sydney, Australia
Purpose of study: To compare a new two-person method (four hands) of delivering mask ventilation with a standard one-person method using the Laerdal self-inflating bag (SIB) and the Neopuff (NP) infant resuscitator in a manikin model. Recent studies of simulated neonatal resuscitation using bag and mask ventilation techniques have shown facemask leak levels of 55–57% in expert hands. Materials and methods: 48 participants were randomly paired and instructed to give mask ventilation for a 2-min period as single-person resuscitators, then as two-person
AP173 The impact of neonatal resuscitation program courses on outcomes of newborns with perinatal asphyxia in Lithuania Kudreviciene A., Kregzdiene R., Petruskeviciene Z., Buinauskiene J. Department of Neonatology, Health Science University, Academy of Medicine, Kaunas, Lihuania Proper help for newborns during first minutes of their life has a crucial impact on their mortality and morbidity. In Lithuania Neonatal Resuscitation Program (NRP) courses were introduced in 2003. Purpose of the study: To evaluate the impact of the NRP on morbidity and mortality of newborn infants with perinatal asphyxia (PA) and development of neonatal hypoxicischaemic encephalopathy (HIE). Material and methods: A retrospective cohort observational study. Medical data of births in Lithuania were analyzed. All infants born in Lithuania in 2001–2002 (“pretraining period” group I) and 2007–2008 (“training-in-progress” group II) were included in the study. Main outcome measures: five-minute Apgar scores, PA-caused neonatal mortality and incidence of HIE. Results: Newborns (121,096) were included. Incidence of infants born with 5-min Apgar scores of 6 and less in group I – 1.25% vs group II – 0.7%. PA-caused neonatal mortality per 1000 live births (0–27 days): group I - 0.65/1000 vs group II – 0.4/1000, early neonatal mortality (0-6 days): group I – 0.55/1000 vs group II – 0.4/1000. PA-caused neonatal mortality per 1000 term live births: group I – 0.3/1000 vs group II – 0.25/1000 (p – 0.02), perinatal PA-caused mortality for term live births: group I – 0.2/1000 vs group II – 0.2/10000 (p – 0.04). Incidence of HIE: group I – 8.3% vs group II – 7.6%, term infants group I – 10.3% vs group II – 3.5%. Conclusion. Since the introduction of Neonatal Resuscitation Program (NRP) in Lithuania, neonatal mortality and morbidity associated with PA decreased near double and the rate of the neonatal hypoxic-ischaemic encephalopathy in terms decreased threefold. doi:10.1016/j.resuscitation.2010.09.318
Service Rijeka, Rijeka, Croatia Ambulance Service Pazin, Pazin, Croatia
Purpose of the study: In paediatric emergencies it is vital to promptly and accurately estimate children’s weight. Child’s weight is used to calculate drug dosages, equipment sizes and energy of defibrillation shock. Our goal was to evaluate the methods for weight estimation of children in our region. Materials and methods: All children aged 0–14 years, who visited clinics of Ambulance Service Rijeka and Pazin in the period of 3 months, during working hours of the authors, were included in the study. A total of 209 children presenting with acute illnesses, excluding life-threatening conditions, had their weight and height measured. Furthermore, their weight was estimated according to methods based on age (formulas: EPLS1 , Argall2 , Best Guess3 , Luscombe and Owens4 ) and length (Broselow tape5 ). Accuracy of methods was defined as agreement within 10% between the actual and estimated weights. Results: Tables 1 and 2.
EPLS Argall Best Guess Luscombe&Owens
paired resuscitators at set pressures for NP and set parameters for SIB. Airway pressure, flow, inspiratory tidal volume, expiratory tidal volume and mask leak were recorded. Results: A total of 21 578 inflations were recorded and analysed. For SIB, mask leak was greater (11.5%) with single-person compared to two-person (5.4%; mean difference 6.1%, 95% CI 1.5–10.7, p < 0.01). For NP, mask leak was greater for single-person (22.2%) compared to two-person (9.1%; mean difference 13.1% 95% CI 3.6–22.6, p < 0.01). For single-person mask ventilation, mask leak was greater with NP (22.2%) compared to SIB (11.5%; mean difference 10.7%, 95% CI 1.4–19.7, p < 0.01). For two-person mask ventilation, mask leak was greater for NP (9.1%) compared to SIB (5.4%; mean difference 3.7%, 95% CI 0.1–6.4, p < 0.05). Conclusions: Two-person mask ventilation technique reduces mask leak by approximately 50% compared to the standard one-person mask ventilation method. NP mask ventilation has higher mask leak than Laerdal SIB for both single- and two-person technique mask ventilation. doi:10.1016/j.resuscitation.2010.09.316 AP172 Ventilator-delivered mask ventilation compared with three standard methods of mask ventilation in a manikin model
Table 1 Age based. Formula
S77
Age (years)
1–10 1–10 0–14 1–10
Total number of children
Number of children accurately estimated
156 156 209 156
Percentage of children accurately estimated (%)
56 72 96 72
36 46 46 46
Table 2 Length based. Method
Length (centimeters)
Total number of children
Number of children accurately estimated
Percentage of children accurately estimated (%)
Broselow tape
46–145
151
88
58
Conclusions: Broselow tape was the most accurate method for weight estimation of children in our study. In majority of cases when it was wrong, it slightly underestimated children’s weight. This could be less dangerous than larger mistakes made by formulas based on age. The most widely used formula in our region, the EPLS formula, demonstrated the poorest estimation accuracy. Our study will continue to include a larger sample of children from different parts of Croatia, and with in-depth analyses of the results, offer recommendations to our medical workers.
Tracy M.B. 1,3 , Klimek J. 1,3 , Coughtrey H. 1,3 , Shingde V. 1,3 , Ponnampalam G. 1 , Hinder M. 1 , Maheshwari R. 1 , Tracy S.K. 2,3 1 Westmead 2 3
Hospital Sydney West Area Health Service, Sydney, Australia Royal Hospital for Women, Sydney, Australia University of Sydney, Sydney, Australia
Purpose: Little is known regarding the variations in effective ventilation during bag and mask resuscitation with standard methods compared with that delivered by ventilator-delivered mask ventilation (VDMV). The aim was to measure the variations in delivered airway pressure, tidal volume (TV), minute ventilation (MV) and inspiratory time during a 3-min period of mask ventilation comparing VDMV with three commonly used hand delivered methods of bag and mask ventilation: Laerdal self-inflating bag (SIB); anaesthetic bag and T-piece Neopuff. Material and methods: A modified resuscitation manikin was used to measure variation in mechanical ventilation during 3-min periods of mask ventilation. Thirty-six experienced practitioners gave positive pressure mask ventilation targeting acceptable chest wall movement with a rate of 60 inflations/min and when pressures could be targeted or set, a peak inspiratory pressure (PIP) of 18 cm water, positive end-expiratory pressure (PEEP) of 5 cm water, for 3 min with each of the four mask ventilation methods. Each mode was randomly sequenced. Results: A total of 21,136 inflations were recorded and analysed. VDMV achieved PIP and PEEP closest to that targeted and significantly lower variation in all measured parameters (p < 0.001) other than with PIP. SIB delivered TV and MV over twice that delivered by VDMV and Neopuff. Conclusion: During 3-min periods of mask ventilation on a manikin, VDMV produced the least variation in delivered ventilation. SIB produced wide variation and unacceptably high TV and MV in experienced hands.
References doi:10.1016/j.resuscitation.2010.09.317 1. European Resuscitation Council. European Paediatric Life Support (EPLS) manual. London: Resuscitation Council (UK); 2006. 2. Argall JA, Wright N, Mackway-Jones K, Jackson R. A comparison of two commonly used methods of weight estimation. Arch Dis Child 2003;88:789–90. 3. Tinning K, Acworth J. Make your Best Guess: an updated method for paediatric weight estimation in emergencies. Emerg Med Aust 2007;19:528–34. 4. Luscombe M, Owens B. Weight estimation in resuscitation: is the current formula still valid? Arch Dis Child 2007;92:412–5. 5. Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell F,W. A rapid method for estimating weight and resuscitation drug dosages from length in the pediatric age group. Ann Emerg Med 1998;17:576–1781. doi:10.1016/j.resuscitation.2010.09.315
Newborn Life Support AP171 Mask leak in one-person mask ventilation compared to two-person in newborn infant manikin study Tracy M.B. 1,3 , Klimek J. 1,3 , Coughtrey H. 1,3 , Shingde V. 1,3 , Ponnampalam G. 1 , Hinder M. 1 , Maheshwari R. 1 , Tracy S.K. 2,3 1 Westmead 2 3
Hospital Sydney West Area Health Service, Sydney, Australia Royal Hospital for Women, Sydney, Australia University of Sydney, Sydney, Australia
Purpose of study: To compare a new two-person method (four hands) of delivering mask ventilation with a standard one-person method using the Laerdal self-inflating bag (SIB) and the Neopuff (NP) infant resuscitator in a manikin model. Recent studies of simulated neonatal resuscitation using bag and mask ventilation techniques have shown facemask leak levels of 55–57% in expert hands. Materials and methods: 48 participants were randomly paired and instructed to give mask ventilation for a 2-min period as single-person resuscitators, then as two-person
AP173 The impact of neonatal resuscitation program courses on outcomes of newborns with perinatal asphyxia in Lithuania Kudreviciene A., Kregzdiene R., Petruskeviciene Z., Buinauskiene J. Department of Neonatology, Health Science University, Academy of Medicine, Kaunas, Lihuania Proper help for newborns during first minutes of their life has a crucial impact on their mortality and morbidity. In Lithuania Neonatal Resuscitation Program (NRP) courses were introduced in 2003. Purpose of the study: To evaluate the impact of the NRP on morbidity and mortality of newborn infants with perinatal asphyxia (PA) and development of neonatal hypoxicischaemic encephalopathy (HIE). Material and methods: A retrospective cohort observational study. Medical data of births in Lithuania were analyzed. All infants born in Lithuania in 2001–2002 (“pretraining period” group I) and 2007–2008 (“training-in-progress” group II) were included in the study. Main outcome measures: five-minute Apgar scores, PA-caused neonatal mortality and incidence of HIE. Results: Newborns (121,096) were included. Incidence of infants born with 5-min Apgar scores of 6 and less in group I – 1.25% vs group II – 0.7%. PA-caused neonatal mortality per 1000 live births (0–27 days): group I - 0.65/1000 vs group II – 0.4/1000, early neonatal mortality (0-6 days): group I – 0.55/1000 vs group II – 0.4/1000. PA-caused neonatal mortality per 1000 term live births: group I – 0.3/1000 vs group II – 0.25/1000 (p – 0.02), perinatal PA-caused mortality for term live births: group I – 0.2/1000 vs group II – 0.2/10000 (p – 0.04). Incidence of HIE: group I – 8.3% vs group II – 7.6%, term infants group I – 10.3% vs group II – 3.5%. Conclusion. Since the introduction of Neonatal Resuscitation Program (NRP) in Lithuania, neonatal mortality and morbidity associated with PA decreased near double and the rate of the neonatal hypoxic-ischaemic encephalopathy in terms decreased threefold. doi:10.1016/j.resuscitation.2010.09.318