Review of CPR for Review of CPR for newborns [2005 AHA]newborns [2005 AHA]

By Elizabeth Kelley Buzbee By Elizabeth Kelley Buzbee A.A.S., R.R.T.-N.P.S., R.C.P.A.A.S., R.R.T.-N.P.S., R.C.P.

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You are called to L & D to assess a You are called to L & D to assess a newborn for CPR.newborn for CPR.

List the 4 questions you ask yourself List the 4 questions you ask yourself about the baby.about the baby.

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1.1. Was this a full term gestation?Was this a full term gestation?

2.2. Is the amniotic fluid clear and Is the amniotic fluid clear and normal?normal?

3.3. Is the baby crying or breathing?Is the baby crying or breathing?

4.4. Is there good Muscle tone?Is there good Muscle tone?

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Your baby is a 27 weeker who is Your baby is a 27 weeker who is 1100 grams.1100 grams.

She is floppy with a heart rate of 88 She is floppy with a heart rate of 88 bpm and gaspingbpm and gasping

She has an Sp02 of 75%She has an Sp02 of 75% What do you do?What do you do?

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Clear the airway, Establish an airway Clear the airway, Establish an airway and mask bag at 100% at a rate of and mask bag at 100% at a rate of 40-60 bpm40-60 bpm

Reassess the HR in 30 secondsReassess the HR in 30 seconds

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After mask bagging for 30 seconds, After mask bagging for 30 seconds, you see that the baby’s chest rises you see that the baby’s chest rises with the bagging at a PIP 25 cwp and with the bagging at a PIP 25 cwp and that the HR is now 45.that the HR is now 45.

What do you do at this point? What do you do at this point?

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Start chest compressions at a rate of Start chest compressions at a rate of 90 bpm with RR 30 1:3 ratio90 bpm with RR 30 1:3 ratio

Reassess in 30 secondsReassess in 30 seconds Go ahead and intubate with a 3.0 Go ahead and intubate with a 3.0

endotracheal tube.endotracheal tube.

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When the doctor intubates the When the doctor intubates the patient with a 3.0 endotracheal tube patient with a 3.0 endotracheal tube he pushes it to the 9 cm depth. he pushes it to the 9 cm depth.

What do you do [someone else is still What do you do [someone else is still doing compressions]doing compressions]

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Check BBS with stethoscope over the Check BBS with stethoscope over the axillary in both left and right.axillary in both left and right.

Check the Sp02 Check the Sp02 If you hear some gross leaking, push If you hear some gross leaking, push

the ET-tube down to the 10 cm mark the ET-tube down to the 10 cm mark [3.0 ET tube][3.0 ET tube]

Re-check the BBS & Sp02 and tape Re-check the BBS & Sp02 and tape the tubethe tube

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You have been doing chest You have been doing chest compressions/ventilation at 1:3 ratio compressions/ventilation at 1:3 ratio for 30 seconds and when you stop for 30 seconds and when you stop compressions you note that the compressions you note that the baby’s HR is now 110.baby’s HR is now 110.

What do you do now?What do you do now?

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Stop compressions, keep bagging at Stop compressions, keep bagging at 40-60 bpm at 100%40-60 bpm at 100%

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The ET tube is in good position based The ET tube is in good position based on assessment of the BBS, but you on assessment of the BBS, but you notice that the Sp02 on 100% notice that the Sp02 on 100% bagging at PIP 24 is only 89%.bagging at PIP 24 is only 89%.

What do you do?What do you do?

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In the first 30 minutes of life. a Sp02 In the first 30 minutes of life. a Sp02 about 90% is acceptable at this time.about 90% is acceptable at this time.

Because the baby most likely has Because the baby most likely has IRDS type I we could add a PEEP IRDS type I we could add a PEEP valve to the bag and place baby on valve to the bag and place baby on PEEP 5 cwp.PEEP 5 cwp.

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You notice that the baby’s belly is You notice that the baby’s belly is getting quite large and tight.getting quite large and tight.

What do you do?What do you do?

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Ask the nurse to place a naso-gastric Ask the nurse to place a naso-gastric tube to vent the excessive air from tube to vent the excessive air from the stomach that is causing a the stomach that is causing a restrictive defectrestrictive defect

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If the baby had not had a good pulse If the baby had not had a good pulse after a few minutes of chest after a few minutes of chest compressions, what would you do?compressions, what would you do?

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If HR is still less than 60 bpm, If HR is still less than 60 bpm, continue CPR & continue CPR &

administer epinephrine [1:10,000] by administer epinephrine [1:10,000] by IV .01 to .03 mg/kg IV .01 to .03 mg/kg