18 September 2012
Of the 224 178 births in Australia in 2009, approximately 28.2% of newborns required some form of resuscitation immediately following birth. As such, the recent revisions made to the basic and advanced paediatric cardiopulmonary resuscitation guidelines by the Australian and New Zealand Resuscitation Councils, discussed by Tibballs et al., are of substantial interest to nursing and medical staff within obstetric hospitals. The resuscitation guidelines are an attempt to incorporate the available scientific knowledge in a pragmatic framework. In our view, the compression-ventilation ratio (CVR) should be maintained at 3:1 during the period that an infant is in the special care nursery and/or post-natal ward.
While the recommended CVR is 3:1 for newborns, the current guidelines for paediatric patients ‘post-birth’ is the compression-focused 15:2 ratio. The rationale for the CVR of 3:1 in newborns is based upon the common respiratory aetiology of infant cardiac arrest. Newborns often become asystolic or bradycardic due to respiratory causes, as they transition from the intra-uterine environment to air breathing. For this reason, the 3:1 CVR is recommended, as this appropriately emphasises ventilation. Additionally, Hemway et al. found that rescuers achieve greater compression depth and consistency when administering the 3:1 ratio, in comparison with the 15:2.
The recommendation regarding the change from the 3:1 to 15:2 ratio should be pragmatic, as there is no clear age point where children benefit more from the 15:2 ratio. In a hospital-based neonatal resuscitation event, the recommendation should optimise ventilation, and minimise confusion about the CVR ratio for resuscitators. We believe that by simplifying the recommendation to maintaining a CVR of 3:1 for infants until discharge from the special care nursery and/or the post-natal ward, the nurses/midwives staffing these areas could be trained in a single infant resuscitation protocol.