Two changes are made to resuscitation practice in delivery room

Correct ventilation techniques

“Ventilation of the lungs is the single most important and most effective step in cardiopulmonary resuscitation of the compromised newborn,” Dr. Weiner said. “If the heart rate is not rapidly increasing, ask if the chest is moving.”

He emphasized that no compressions should occur until after at least 30 seconds of PPV that moves the chest. He provided a “MR. SOPA” acronym: Mask adjustment, Reposition airway, Suction, Open mouth, Pressure increase, Alternative airway.

You also should be aware of possible leaking or obstruction around the mask, which is common, he said, so monitor pressure instead of volume.

“We are not good at identifying leak, obstruction, or adequate tidal volume,” Dr. Weiner said. “A colorimetric CO₂ detector attached to the mask is a simple indicator of gas exchange” (Resuscitation. 2014 Nov;85[11]:1568-72).

He also strongly recommended inserting an alternative airway before starting chest compressions with either intubation or a laryngeal mask.

Dr. Weiner concluded with the following list of clinical practice changes you may consider:

• Use a standardized equipment checklist.
• Develop and practice standardized scripts.
• Debrief after all resuscitations; use videotape if you can.
• Delay cord clamping for most term and preterm babies.
• Do not routinely intubate/suction nonvigorous newborns with MSAF. Initiate resuscitation.
• Use an electronic cardiac monitor if resuscitation is required.
• Use a colorimetric CO₂ detector with PPV.
• Intubate or place a laryngeal mask before starting compressions.

Dr. Weiner reported having no disclosures, and no external funding was used for the presentation.