Electrocardiography vs. Auscultation to Assess Heart Rate During Cardiac Arrest With Pulseless Electrical Activity in Newborn Infants
Background: In 2015, the neonatal resuscitation guidelines incorporated the use of electrocardiography (ECG) to monitor heart rate of newborns. However, previous studies have indicated that cardiac arrest with pulseless electrical activity rhythm (PEA) may occur in the delivery room, rendering this...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2018-11-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fped.2018.00366/full |
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| author | Deandra H. Luong Deandra H. Luong Po-Yin Cheung Po-Yin Cheung Megan O'Reilly Tze-Fun Lee Georg M. Schmolzer Georg M. Schmolzer |
| author_facet | Deandra H. Luong Deandra H. Luong Po-Yin Cheung Po-Yin Cheung Megan O'Reilly Tze-Fun Lee Georg M. Schmolzer Georg M. Schmolzer |
| author_sort | Deandra H. Luong |
| collection | DOAJ |
| description | Background: In 2015, the neonatal resuscitation guidelines incorporated the use of electrocardiography (ECG) to monitor heart rate of newborns. However, previous studies have indicated that cardiac arrest with pulseless electrical activity rhythm (PEA) may occur in the delivery room, rendering this method problematic.Objective: To evaluate the accuracy of ECG and auscultation to assess heart rate during PEA.Methods: A total of 45 piglets (age 1–3 days, weight 1.7–2.3 kg) were exposed to 30 min normocapnic alveolar hypoxia followed by asphyxia until asystole, achieved by disconnecting the ventilator and clamping the endotracheal tube. During asphyxia, heart rate (HR) was assess using auscultation, ECG, and carotid blood flow (CBF). At the time of asystole (defined as zero CBF) HR auscultated using a neonatal/infant stethoscope was compared to ECG traces.Results: The median (IQR) duration of asphyxia was 325 (200–491) s. In 8 (18%) piglets, CBF, ECG, and auscultation identified asystole. In 22 (49%) piglets no CBF and no audible heart sounds, were observed, while ECG displayed a HR ranging from 17 to 75/min. Fifteen (33%) piglets remained bradycardic (defined as HR of < 100/min) after 10 min of asphyxia, which was identified by CBF, ECG, and auscultation. The overall accuracy of ECG and auscultation in the detection of HR were 51 and 80%, respectively (p = 0.004).Conclusion: In cases with PEA ECG is not superior in correctly identifying HR in newborn piglets. |
| first_indexed | 2024-12-14T12:22:20Z |
| format | Article |
| id | doaj.art-7332cf2cfce042a2884b8b643b926a0b |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-14T12:22:20Z |
| publishDate | 2018-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-7332cf2cfce042a2884b8b643b926a0b2022-12-21T23:01:28ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602018-11-01610.3389/fped.2018.00366425927Electrocardiography vs. Auscultation to Assess Heart Rate During Cardiac Arrest With Pulseless Electrical Activity in Newborn InfantsDeandra H. Luong0Deandra H. Luong1Po-Yin Cheung2Po-Yin Cheung3Megan O'Reilly4Tze-Fun Lee5Georg M. Schmolzer6Georg M. Schmolzer7Faculty of Science, University of AlbertaEdmonton, AB, CanadaCentre for the Studies of Asphyxia and Resuscitation, Royal Alexandra HospitalEdmonton, AB, CanadaCentre for the Studies of Asphyxia and Resuscitation, Royal Alexandra HospitalEdmonton, AB, CanadaDepartment of Pediatrics, Faculty of Medicine and Dentistry, University of AlbertaEdmonton, AB, CanadaCentre for the Studies of Asphyxia and Resuscitation, Royal Alexandra HospitalEdmonton, AB, CanadaCentre for the Studies of Asphyxia and Resuscitation, Royal Alexandra HospitalEdmonton, AB, CanadaCentre for the Studies of Asphyxia and Resuscitation, Royal Alexandra HospitalEdmonton, AB, CanadaDepartment of Pediatrics, Faculty of Medicine and Dentistry, University of AlbertaEdmonton, AB, CanadaBackground: In 2015, the neonatal resuscitation guidelines incorporated the use of electrocardiography (ECG) to monitor heart rate of newborns. However, previous studies have indicated that cardiac arrest with pulseless electrical activity rhythm (PEA) may occur in the delivery room, rendering this method problematic.Objective: To evaluate the accuracy of ECG and auscultation to assess heart rate during PEA.Methods: A total of 45 piglets (age 1–3 days, weight 1.7–2.3 kg) were exposed to 30 min normocapnic alveolar hypoxia followed by asphyxia until asystole, achieved by disconnecting the ventilator and clamping the endotracheal tube. During asphyxia, heart rate (HR) was assess using auscultation, ECG, and carotid blood flow (CBF). At the time of asystole (defined as zero CBF) HR auscultated using a neonatal/infant stethoscope was compared to ECG traces.Results: The median (IQR) duration of asphyxia was 325 (200–491) s. In 8 (18%) piglets, CBF, ECG, and auscultation identified asystole. In 22 (49%) piglets no CBF and no audible heart sounds, were observed, while ECG displayed a HR ranging from 17 to 75/min. Fifteen (33%) piglets remained bradycardic (defined as HR of < 100/min) after 10 min of asphyxia, which was identified by CBF, ECG, and auscultation. The overall accuracy of ECG and auscultation in the detection of HR were 51 and 80%, respectively (p = 0.004).Conclusion: In cases with PEA ECG is not superior in correctly identifying HR in newborn piglets.https://www.frontiersin.org/article/10.3389/fped.2018.00366/fullinfantsnewbornneonatal resuscitationasphyxiaheart rateelectrocardiography |
| spellingShingle | Deandra H. Luong Deandra H. Luong Po-Yin Cheung Po-Yin Cheung Megan O'Reilly Tze-Fun Lee Georg M. Schmolzer Georg M. Schmolzer Electrocardiography vs. Auscultation to Assess Heart Rate During Cardiac Arrest With Pulseless Electrical Activity in Newborn Infants Frontiers in Pediatrics infants newborn neonatal resuscitation asphyxia heart rate electrocardiography |
| title | Electrocardiography vs. Auscultation to Assess Heart Rate During Cardiac Arrest With Pulseless Electrical Activity in Newborn Infants |
| title_full | Electrocardiography vs. Auscultation to Assess Heart Rate During Cardiac Arrest With Pulseless Electrical Activity in Newborn Infants |
| title_fullStr | Electrocardiography vs. Auscultation to Assess Heart Rate During Cardiac Arrest With Pulseless Electrical Activity in Newborn Infants |
| title_full_unstemmed | Electrocardiography vs. Auscultation to Assess Heart Rate During Cardiac Arrest With Pulseless Electrical Activity in Newborn Infants |
| title_short | Electrocardiography vs. Auscultation to Assess Heart Rate During Cardiac Arrest With Pulseless Electrical Activity in Newborn Infants |
| title_sort | electrocardiography vs auscultation to assess heart rate during cardiac arrest with pulseless electrical activity in newborn infants |
| topic | infants newborn neonatal resuscitation asphyxia heart rate electrocardiography |
| url | https://www.frontiersin.org/article/10.3389/fped.2018.00366/full |
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