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Use of Feedback CPR Devices for Neonatal Cardiac Arrest

Question Type:
Intervention
Full Question:
In asystolic/bradycardic neonates receiving cardiac compressions (P), does feedback devices such as ETCO2 monitors, pulse oximeters, or automated compression feedback devices  (I), compared with clinical assessments of compression efficacy (C), change  (O)?
Consensus on Science:
For the critical outcomes of improved perfusion, decreased time to ROSC, decreased hands-off time, increased survival rates, or improved neurologic outcomes, we found no specific data.Increased exhaled CO2: Five small observational studies (2 piglet posttransitioned models, (Berg 1996, 245; Chalak 2011, 401) 2 dog posttransitioned models(Bhende 1995, 365; Bhende 1996, 349) (these latter 2 articles were the identical sample of dogs and data but published in separate journals), and 1 human study (Bhende 1995, 365) of very low quality (downgraded for indirectness and risk of bias) assessed the ETCO2 levels associated with the onset or presence/absence of ROSC. One piglet study(Berg 1996, 245) and the dog studies(Bhende 1996, 349) associated the presence of decreased time to ROSC with an ETCO2 of 27 to 28 mm Hg. CPR in these studies was started after 5 to 10 minutes of cardiac arrest. One piglet study (Chalak 2011, 401) associated the presence of a heart rate greater than 60/min with an ETCO2 of 14 mm Hg (sensitivity, 93%; specificity, 81%). CPR was started at onset of asystole. One human study covered a wide age range of children, 1 week to 10 years.(Bhende 1995, 395) The majority were out-of-hospital arrests. ETCO2 levels in all patients who did not attain ROSC never rose above 15 mm Hg.
Treatment Recommendation:
In asystolic/bradycardic neonates, we suggest against the routine reliance on any single feedback device such as ETCO2 monitors or pulse oximeters for detection of ROSC until more evidence becomes available (weak recommendation, very-low-quality evidence).Values, Preferences, and Task Force Insights Several questions were raised: Should detection of ROSC be the only real outcome for the question because identifying this is the first step to recovery? Thus, it is a critical tool for determining if your actions are effective or if you need to consider other interventions. Was there a need to rate the effectiveness of the equipment as the critical outcome, or is the effect on the patient what is important? Does the device measure what it is supposed to measure? What about human factors issues? Can providers effectively use the equipment? Does it impact outcome?
CoSTR Attachments:
Should Feedback devices ETCO2 etc vs. auscultation _ clinical assessment of compression efficacy be -7_n.docx    
Summary of Bias Assessments_n.xlsx    

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