Survival After Delivery Room Cardiopulmonary Resuscitation: A National Registry Study

Overview

Journal Resuscitation

Specialty Emergency Medicine

Date 2020 Jan 27

PMID 31982507

Citations 7

Authors

Elizabeth E Foglia

Erik A Jensen

Myra H Wyckoff

Taylor Sawyer

Alexis Topjian

Sarah J Ratcliffe

Affiliations

Soon will be listed here.

Abstract

Aims: Survival after delivery room cardiopulmonary resuscitation (DR-CPR) is not well characterized in full-term infants, and survival outcomes after DR-CPR have not been defined across the spectrum of gestation. The study objectives were to define gestational age (GA) specific survival following DR-CPR and to assess the association between GA and DR-CPR characteristics and survival outcomes.

Methods: Retrospective cohort study of prospectively collected data in the American Heart Association Get With the Guidelines-Resuscitation registry. Newborn infants without congenital abnormalities who received greater than 1 min of chest compressions for DR-CPR were included. GA was stratified by categorical subgroups: ≥36 weeks; 33-35 weeks; 29-32 weeks; 25-28 weeks; 22-24 weeks. The primary outcome was survival to hospital discharge; the secondary outcome was return of circulation (ROC).

Results: Among 1022 infants who received DR-CPR, 83% experienced ROC and 64% survived to hospital discharge. GA-stratified hospital survival rates were 83% (≥36 weeks), 66% (33-35 weeks), 60% (29-32 weeks), 52% (25-28 weeks), and 25% (22-24 weeks). Compared with GA ≥ 36 weeks, lower GA was independently associated with decreasing odds of survival (33-35 weeks: adjusted Odds Ratio [aOR] 0.46, 95% Confidence Interval [CI] 0.26-0.81; 29-32 weeks: aOR 0.40, 95% CI 0.23-0.69; 25-28 weeks: aOR 0.21, 95% CI 0.11-0.41; 22-24 weeks: aOR 0.06, 95% CI 0.03-0.10).

Conclusions: In this national registry of infants who received delivery room cardiopulmonary resuscitation (DR-CPR), 83% survived the event and two-thirds survived to hospital discharge. These results contribute to defining survival outcomes following DR-CPR across the continuum of gestation.

Citing Articles

Neonatal Resuscitation Online Registry in Shenzhen: protocol for a prospective, multicentre, open, observational cohort study.

Lin H, Han J, Jiang P, Yu Z, Zhou P, Tang H BMJ Open. 2024; 14(6):e081670.

PMID: 38858150 PMC: 11168126. DOI: 10.1136/bmjopen-2023-081670.

Assessing the influence of abdominal compression on time to return of circulation during resuscitation of asphyxiated newborn lambs: a randomised preclinical study.

Polglase G, Hwang C, Blank D, Badurdeen S, Crossley K, Kluckow M Arch Dis Child Fetal Neonatal Ed. 2023; 109(4):405-411.

PMID: 38123977 PMC: 11228194. DOI: 10.1136/archdischild-2023-326047.

Is epinephrine effective during neonatal resuscitation?.

Sankaran D, Molloy E, Lakshminrusimha S Pediatr Res. 2022; 93(3):466-468.

PMID: 36509848 PMC: 9998334. DOI: 10.1038/s41390-022-02411-2.

Epidemiologic study of in-hospital cardiopulmonary resuscitation among pediatric patients: A retrospective, population-based cohort study in South Korea.

Oh T, Choi C, Song I Medicine (Baltimore). 2022; 101(36):e30445.

PMID: 36086791 PMC: 10980375. DOI: 10.1097/MD.0000000000030445.

[Clinical features of preterm infants with a birth weight less than 1 500 g undergoing different intensities of resuscitation: a multicenter retrospective analysis].

Qian M, Yu Z, Chen X, Xu Y, Ma Y, Jiang S Zhongguo Dang Dai Er Ke Za Zhi. 2021; 23(6):593-598.

PMID: 34130781 PMC: 8214002.

References

McGrath J, Roehr C, Wilkinson D . When should resuscitation at birth cease?. Early Hum Dev. 2016; 102:31-36. DOI: 10.1016/j.earlhumdev.2016.09.005. View

Nadkarni V, Larkin G, Peberdy M, Carey S, Kaye W, Mancini M . First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006; 295(1):50-7. DOI: 10.1001/jama.295.1.50. View

Collins Jr J, Hammond N . Relation of maternal race to the risk of preterm, non-low birth weight infants: a population study. Am J Epidemiol. 1996; 143(4):333-7. DOI: 10.1093/oxfordjournals.aje.a008747. View

Halling C, Sparks J, Christie L, Wyckoff M . Efficacy of Intravenous and Endotracheal Epinephrine during Neonatal Cardiopulmonary Resuscitation in the Delivery Room. J Pediatr. 2017; 185:232-236. DOI: 10.1016/j.jpeds.2017.02.024. View

Fischer N, Soraisham A, Shah P, Synnes A, Rabi Y, Singhal N . Extensive cardiopulmonary resuscitation of preterm neonates at birth and mortality and developmental outcomes. Resuscitation. 2019; 135:57-65. DOI: 10.1016/j.resuscitation.2019.01.003. View

Goel D, DCruz D, Jani P . Outcomes of infants born at borderline viability (23-25 weeks gestation) who received cardiopulmonary resuscitation at birth. J Paediatr Child Health. 2018; 55(4):399-405. DOI: 10.1111/jpc.14210. View

Perlman J, Risser R . Cardiopulmonary resuscitation in the delivery room. Associated clinical events. Arch Pediatr Adolesc Med. 1995; 149(1):20-5. DOI: 10.1001/archpedi.1995.02170130022005. View

Nelson K, Bingham P, Edwards E, Horbar J, Kenny M, Inder T . Antecedents of neonatal encephalopathy in the Vermont Oxford Network Encephalopathy Registry. Pediatrics. 2012; 130(5):878-86. PMC: 4074646. DOI: 10.1542/peds.2012-0714. View

Matos R, Watson R, Nadkarni V, Huang H, Berg R, Meaney P . Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests. Circulation. 2013; 127(4):442-51. DOI: 10.1161/CIRCULATIONAHA.112.125625. View

10.

DeMauro S, Roberts R, Davis P, Alvaro R, Bairam A, Schmidt B . Impact of delivery room resuscitation on outcomes up to 18 months in very low birth weight infants. J Pediatr. 2011; 159(4):546-50.e1. DOI: 10.1016/j.jpeds.2011.03.025. View

11.

Sproat T, Hearn R, Harigopal S . Outcome of babies with no detectable heart rate before 10 minutes of age, and the effect of gestation. Arch Dis Child Fetal Neonatal Ed. 2016; 102(3):F262-F265. DOI: 10.1136/archdischild-2016-311041. View

12.

Soraisham A, Lodha A, Singhal N, Aziz K, Yang J, Lee S . Neonatal outcomes following extensive cardiopulmonary resuscitation in the delivery room for infants born at less than 33 weeks gestational age. Resuscitation. 2014; 85(2):238-43. DOI: 10.1016/j.resuscitation.2013.10.016. View

13.

Wyckoff M, Aziz K, Escobedo M, Kapadia V, Kattwinkel J, Perlman J . Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2):S543-60. DOI: 10.1161/CIR.0000000000000267. View

14.

Perkins G, Jacobs I, Nadkarni V, Berg R, Bhanji F, Biarent D . Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison.... Resuscitation. 2014; 96:328-40. DOI: 10.1016/j.resuscitation.2014.11.002. View

15.

Shah P . Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a systematic review and meta-analyses. J Perinatol. 2009; 29(10):655-61. DOI: 10.1038/jp.2009.71. View

16.

Kumar V, Skrobacz A, Ma C . Impact of bradycardia or asystole on neonatal cardiopulmonary resuscitation at birth. Pediatr Int. 2017; 59(8):891-897. DOI: 10.1111/ped.13310. View

17.

Jacobs S, Berg M, Hunt R, Tarnow-Mordi W, Inder T, Davis P . Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013; (1):CD003311. PMC: 7003568. DOI: 10.1002/14651858.CD003311.pub3. View

18.

Foglia E, Te Pas A . Effective ventilation: The most critical intervention for successful delivery room resuscitation. Semin Fetal Neonatal Med. 2018; 23(5):340-346. PMC: 6288818. DOI: 10.1016/j.siny.2018.04.001. View

19.

Wolfe H, Sutton R, Reeder R, Meert K, Pollack M, Yates A . Functional outcomes among survivors of pediatric in-hospital cardiac arrest are associated with baseline neurologic and functional status, but not with diastolic blood pressure during CPR. Resuscitation. 2019; 143:57-65. PMC: 7050270. DOI: 10.1016/j.resuscitation.2019.08.006. View

20.

Singh J, Fanaroff J, Andrews B, Caldarelli L, Lagatta J, Plesha-Troyke S . Resuscitation in the "gray zone" of viability: determining physician preferences and predicting infant outcomes. Pediatrics. 2007; 120(3):519-26. DOI: 10.1542/peds.2006-2966. View