2010 AHA Guidelines for Cardiopulmonary Resuscitation

What other major guideline changes and recommendations have been made by the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care?

• Prevent hypothermia. Some studies have suggested that the asphyxiated infant, born at 36 weeks gestation or greater, with moderate to severe hypoxic-ischemic encephalopathy who underwent induced hypothermia had lower mortality risks and less neurodevelopmental disability than similar infants who were not cooled. However, induced hypothermia is recommended only for those infants who were at 36 or more weeks’ gestation that meet the strict criteria of hypoxic-ischemic encephalopathy, and studied protocols should be followed.

• Intrapartum routine suctioning of the newborn’s nose and mouth is not recommended.

• Color is no longer used as an indicator of oxygenation or effectiveness of resuscitation.

• 100% oxygen has been traditionally used during positive-pressure ventilation. Resuscitation of infants (term or preterm) should begin with air or blended oxygen with the goal of preductal Sp o norms.

• Pulse oximeters are a reliable indication of oxygenation as long as there is sufficient cardiac output and skin blood flow.

• A laryngeal mask may be used as an alternative airway method. The laryngeal mask may be used by trained providers when bag-mask ventilation is ineffective or attempts at endotracheal intubation have been unsuccessful.

• CO detectors are effective methods of confirmation of endotracheal intubation in the newly born (term to very low birth weight infants).

• The two-thumb method of chest compressions is the preferred method, with the depth of compression being one third of the anteroposterior diameter of the chest rather than a fixed depth. Compression should be deep enough to generate a pulse.

• Administer epinephrine if the heart rate remains at or under 60 beats per minute after 30 seconds of adequate ventilation and chest compressions.

• Albumin-containing solutions are no longer the fluid of choice for initial volume expansion. Isotonic crystalloids are the first choice.

• Intraosseous access can be used if the umbilical vein is not readily available.

• Both simulations and debriefings of neonatal resuscitations can improve knowledge and skills and should be used for acquisition and maintenance of skills.


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