Determining the duration of cardiopulmonary resuscitation (CPR) after birth remains a critically important and difficult management decision. It is a topic of ongoing uncertainty for which we all ask the question, “Is there a specific time frame of CPR after birth that optimizes either survival or neurodevelopmental outcomes?”
In 2015, the International Liaison Committee on Resuscitation (ILCOR) Neonatal Task Force published a consensus on science with treatment recommendations (CoSTR) for neonatal resuscitation suggesting that it may be reasonable to discontinue resuscitation after 10 minutes if the heart rate remains undetectable.1 With additional studies now available, Dr. Elizabeth Foglia and colleagues performed a detailed systematic review (10.1542/peds.2020-1449) on the evidence for ongoing resuscitation beyond ten minutes after birth on the outcomes of survival and neurodevelopment. This newly released review article in Pediatricsforms the scientific basis to support the revised 2020 ILCOR CoSTR recommendations on this topic.2
The authors found that while infants with an ongoing need for CPR at ten minutes after birth are at high risk for mortality and neurodisability, survival without neurodevelopmental impairment is possible. The new treatment recommendations do not provide a single uniform recommended time for when to discontinue resuscitation. Rather, based on the available evidence, it is now suggested that if there is no response to ongoing resuscitation and all steps of resuscitation have been completed, 20 minutes would be a reasonable time to discontinue resuscitation, as opposed to 10 minutes previously published in 2015.
Given the unique circumstances surrounding each resuscitation, Dr. Elizabeth Foglia and colleagues provide a list of important contextual factors to keep in mind, including but not limited to: gestational age of the infant, presence of any congenital anomalies, the timing of perinatal insult, and the family’s preferences and values. Other logistical considerations include the quality of resuscitative efforts performed, and the availability of post-resuscitative neuroprotective resources.
Articles such as this help delivery room providers keep their finger on the pulse and stay up to date on the evidence-based care. For more information on a practical approach to discontinuing resuscitation follow the link.
References
- Perlman JM, Wyllie J, Kattwinkel J, et al. Part 7: Neonatal Resuscitation: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(16 Suppl 1):S204-41
- Foglia EE, Weiner G, de Almeida MF, et al. Impact of duration of intensive neonatal resuscitation at birth. International Liaison Committee on Resuscitation (ILCOR) Neonatal Life Support Task Force. http://ilcor.org. February 19, 2020. Accessed August 7, 2020.
