Suboptimal heart rate assessment and airway management in infants receiving delivery room chest compressions: a quality assurance project

Abstract

Objective: In a previous audit, we demonstrated poor compliance with the neonatal resuscitation algorithm. Training can improve guideline compliance and performance. We aimed to prospectively collect detailed data on delivery room resuscitations to identify needs for educational interventions.

Design: Observational study using video recordings of neonatal resuscitations. We analysed episodes where chest compressions (CCs) were provided.

Setting: A Norwegian university hospital.

Patients: All delivery room resuscitations August 2014 to November 2016.

Interventions: The recordings were transcribed using Interact V.9 software (Mangold Int GmbH, Arnstorf, Germany). Supplementary information was collected from the patient electronic records.

Main outcome measures: Heart rate (HR) assessment, provision of positive pressure ventilation (PPV) and CC, endotracheal intubation and team communication.

Results: Twenty-nine CC episodes were analysed. We identified team discordance in the decisions to perform CC and only 6 (21%) were retrospectively judged to be in need for CC: 8 (28%) infants had adequate spontaneous respiration, 18 (62%) infants received ineffective PPV and 5 (17%) had a HR >60 bpm. Only one infant was intubated before CC, and we could not identify a consistent pattern of ventilation corrective actions. One infant received CC without prior HR assessment. In some infants, CC duration was exceedingly short, and 11 (38%) of the infants that received CC were not admitted to the NICU. Six (21%) infants had no documentation of CPR in the delivery record.

Conclusions: Education and training should focus on team function and communication, correct and timely HR assessment, effective PPV, and indications for endotracheal intubation.

Keywords: medical education; neonatology; resuscitation.