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ECG/ EKG (I) in comparison to oximetry or auscultation

Question Type:
Full Question:
In babies requiring resuscitation (P), does ECG/ EKG (I), compared with oximetry or auscultation (C), change measure heart rate faster and more accurately (O)?
Consensus on Science:
For the important outcomes of fast and accurate measurement of heart rate in babies requiring resuscitation, we have identified Very-low-quality evidence from 5 nonrandomized studies enrolling 213 patients showing a benefit of ECG compared with oximetry(Kamlin 2008, 756; Katheria 2012, e1177; Mizumoto 2012, 205; Dawson 2013, 955; van Vonderen 2015, 49) Very-low-quality evidence from 1 nonrandomized study enrolling 26 patients showing a benefit of ECG compared with auscultation(Kamlin 2006, 319) The available evidence is from nonrandomized studies, downgraded for indirectness and imprecision.
Treatment Recommendation:
In babies requiring resuscitation, we suggest the ECG can be used to provide a rapid and accurate estimation of heart rate (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights There was much discussion and heated debate about the use of ECG to determine heart rate. Although the data suggest that the ECG provides a more accurate heart rate in the first 3 minutes, there were no available data to determine how outcomes would change by acting (or not acting) on the information. Important issues were raised about inappropriate interventions being implemented based on a falsely low heart rate by pulse oximetry or auscultation that might be avoided if the heart rate could be determined by ECG. It was pointed out that pulse oximetry is still very important for the measurement of saturation values to define supplementary oxygen needs. Introducing ECG leads in the delivery room will take time, as will acquiring methods to rapidly apply electrodes. In view of these findings of false-positive readings by conventional means, we have no data on when to advise appropriate actions for bradycardia detected by the conventional measures such as PO or auscultation. Some transient bradycardia may be normal and be reflective of timing of cord clamping. More studies are needed.
CoSTR Attachments:
GRADE GRID - 898.pdf    

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