The 2010 Guidelines on Neonatal Resuscitation (AHA, ERC, ILCOR): Similarities and Differences – What Progress Has Been Made since 2005?

Abstract

In 2010, the American Heart Association (AHA), the European Resuscitation Council (ERC) and the International Liaison Committee on Resuscitation (ILCOR) issued new guidelines on newborn resuscitation. The new recommendations include: (1) pulse-oximetry for patient assessment during newborn resuscitation; (2) to start resuscitation of term infants with an FiO₂ of 0.21; (3) cardio-respiratory resuscitation with a 3:1 chest compression/inflation ratio for a heart rate <60 beats/min; (4) regarding infants born from meconium stained amniotic fluid: no recommendation is given to suction the upper airways at the perineum (when the head is born), but it is recommended to inspect the oropharynx and trachea for obstruction and suction the lower airway before inflations are given when the infant is depressed; (5) for birth asphyxia in term or near term infants, to induce hypothermia (33.5–34.5°C) within 6 h after birth. AHA, ERC and ILCOR used nearly identical literature for their evidence evaluation process. While the AHA and ILCOR guidelines are almost identical, the ERC guidelines differ slightly from the latter with regards to (i) promoting sustained inflations at birth, (ii) promoting a wider range in applied inflations during resuscitation, and (iii) to suction the airways in infants born from meconium stained amniotic fluid, before inflations are given.

Zusammenfassung

Die American Heart Association (AHA), die European Resuscitation Council (ERC) und das International Liaison Committee on Resuscitation (ILCOR) veröffentlichten im Oktober 2010 die aktualisierten Fassungen ihrer jeweiligen Richtlinien für die Reanimation von Neugeborenen. Die neuen Richtlinien beinhalten den Einsatz von (1) Pulsoxymetrie zur Beurteilung des deprimierten Neugeborenen während der Erstversorgung; (2) einem initialen Atemgas ohne O₂-Zumischung (FiO₂ 0,21) bei Reifgeborenen; (3) einem kardialen Kompressions- zu Ventilationsverhältnis von 3:1 bei persistierend niedriger Herzfrequenz <60/min; (4) bez. mekoniumhaltigen Fruchtwassers: keine Empfehlung für oder wider das intratracheale Absaugen bei Geburt des Kopfes (am Perineum) und beim deprimierten Kind die Inspektion zum Ausschluss von Verlegung des Orophyarynx und der tieferen Atemwege durch Mekonium sowie ggf. Absaugen dessen, bevor Atemunterstützung gegeben wird; (5) die Abkühlung der Körperkerntemperatur auf 33,5–34,5°C innerhalb der ersten 6h bei Geburtsasphyxie reifer oder annähernd reifer Neugeborener. Die AHA, ERC und ILCOR geben annähernd identische Textquellen zur Begründung ihrer Empfehlungen an. Die Empfehlungen der AHA und ILCOR sind annähernd identisch, die ERC-Empfehlungen weichen allerdings geringfügig von diesen beiden ab: Der ERC empfiehlt (i) prolongierte Inspirationszeiten während der ersten Atemhübe, (ii) einen breiteren Zielbereich an Atemfrequenzen in der Wiederbelebung und (iii) das konsequente Absaugen der Atemwege im Falle von mekoniumhaltigem Fruchtwasser.

Key words

resuscitation - guideline - monitoring - oxygen - saturation - neonate - newborn

Schlüsselwörter

Reanimation - Richtlinie - Überwachung - Sauerstoff - Neugeborenes

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