Pre-Hospital Newborn Resuscitation: The Ten Minute Dilemma

(Photo: National Highway Traffic Safety Administration) A baby is treated in the back of an ambulance in his undated photo.   An ambulance is dispatched to a full-term imminent birth. As they arrive, the newborn is delivered and, after a minute shows no signs of cardiorespiratory effort. Newborn resuscitation is delivered and despite best efforts the situation is becoming increasingly futile. Five minutes have passed with no detectable cardiac activity; the midwife and additional paramedics are five minutes away, the nearest hospital fifteen. Should the paramedic crew decide to stay or leave? In 2012, the World Health Organisation (WHO) advised that resuscitation ought to be discontinued after ten minutes, should newborn babies have no detectable heart rate.1 This is reflected globally in North American, UK, and European paediatric guidelines.2-4 Further, pre- and in-hospital newborn resuscitation principles are identical, where additional skills such as establishing an umbilical venous line to administer drug treatments remain a poor outcome determinant. If futility is considered as an unachievable goal with no useful or effective purpose, then we could claim that in this instance, conveyance to hospital is futile. The cost of resources at hospital, including clinicians and treatments, the emotional distress, the risk of pre-hospital blue-light conveyance, and the act of separating the parents from the newborn outweigh the speculative benefit that all options have ...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Exclusive Articles Source Type: news