Characterizing prehospital response to neonatal resuscitation

Trang Kieu Huynh; Amanda Schoonover; Tabria Harrod; Nathan Bahr; Jeanne-Marie Guise

doi:10.1016/j.resplu.2021.100086

Characterizing prehospital response to neonatal resuscitation

Resusc Plus. 2021 Feb 6:5:100086. doi: 10.1016/j.resplu.2021.100086. eCollection 2021 Mar.

Authors

Trang Kieu Huynh¹, Amanda Schoonover², Tabria Harrod², Nathan Bahr³, Jeanne-Marie Guise²

Affiliations

¹ Department of Pediatrics, Oregon Health and Science University, United States.
² Department of Obstetrics and Gynecology, Oregon Health and Science University, United States.
³ Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, United States.

Abstract

Objective: To evaluate performance of initial steps of newborn resuscitation according to the American Heart Association and American Academy of Pediatrics' Neonatal Resuscitation Program (NRP) guidelines in the prehospital setting.

Study design: Observational study of 265 paramedics and Emergency Medical Technicians (EMTs) from 45 EMS teams recruited from public fire and private transport agencies in a major metropolitan area. Participants completed a baseline questionnaire assessing demographics, experience, and comfort in caring for children. Simulations were conducted April 2015 to March 2016. Technical performance was evaluated by blinded video review. NRP actions were assessed using a structured performance tool.

Results: Two hundred sixty-five EMS providers responded to survey questions and participated in simulations. In total, 16% reported feeling very or extremely comfortable caring for children <30 days of age (vs. 71% for children aged 12-18 years). Among 45 EMS teams participating in simulations, 22% (n = 10) dried, 18% (n = 8) stimulated, and 2% (n = 1) warmed within 30 s from arrival and 11% (n = 5) provided BMV within 60 s from arrival, as recommended by NRP. All teams provided BMV. Eighty-eight percent bagged below NRP rate recommendations and 96% bagged with tidal volume exceeding guidelines. Looking over the entire 10-min simulation for ever performing measures, 73% started to dry the baby within a median of 51 (range 0-539) seconds from arrival, 38% started to stimulate the baby within a median of 34 s (range 0-181), and 44% started to warm the baby within a median 291 s (range 27-575 s).

Conclusions: These data from field simulations suggest NRP steps recommended for the first minute after birth are seldom performed in a timely manner and suggests opportunities for improvement.

Keywords: AAP, American Academy of Pediatrics; BMV, bag mask ventilation; EMS, Emergency Medical Service; EMS-C, Emergency Medical Services of Children; EMTs, Emergency Medical Technicians; Emergency medical service; FRC, functional residual capacity; NRP, Neonatal Resuscitation Program; Neonatal resuscitation; Newborn care; Prehospital.