1. NRP: 862: Use of Feedback CPR Devices for Neonatal Cardiac Arrest NRP: 863: Use of Feedback CPR Devices to detect ROSC for Neonatal Cardiac Arrest
TFQO: Lindsay Mildenhall
EVREVs: Lindsay Mildenhall COI 107
and Takahiro Sugiura
Taskforce:NRP

2. COI Disclosure (specific to this systematic review)
EVREV 1 COI 107
Commercial/industry
Nil
Potential intellectual conflicts
EVREV 2 COI

3. 2010 CoSTR
Topic not reviewed in 2010

4. C2015 PICO
Population: In asystolic/bradycardic neonates receiving cardiac compressions
Intervention:does feedback devices such as ETCO2 monitors, pulse oximeters, or automated compression feedback devices
Comparison:compared with clinical assessments of compression efficacy
Outcomes:
9-Critical decreased hands off time
9-Critical improve perfusion
8-Critical decrease time to ROSC
8-Critical increase survival rates
7-Critical improve neurological outcomes

5. Inclusion/Exclusion & Articles Found
Inclusions
Neonatal / Infant / Animal / Manikins
RCT, Observational
Exclusions: Adult, V-Fib, Abstracts, Editorials
Number of Articles initially identified 691
Included in Evidence Profile tables 5 (All ETCO2)
RCTs 0
non-RCTs 5
Excluded 686

6. Draft Treatment Recommendations
NRP: 862
In asystolic/bradycardic neonates we suggest against the routine reliance on any single feedback device such as ETCO2 monitors or pulse oximeters until more evidence becomes available
(weak recommendation, very low quality of evidence).

7. Risk of Bias in studies

8. Key data from key studies
Asphyxial Arrest (ETT clamped):
11 dogs HR = 0
All achieved ROSC
Bhende MS et al Am J Emerg Med Jul;14(4):

9. 40 children (aged 1 week to 10 years):
Easy-Cap (Nellcor)
mmHg (< 2%) Yellow
4 - < 15mmHg
Tan (0.5 – 2%)
< 4mmHg (< 0.5%) Purple
40 children (aged 1 week to 10 years):
Patients with higher initial ETCO2 signif. association with ROSC. 75% with >2.0% (>15mmHg) vs.
32% in the range 0.5 to 2.0% (4-15mmHg)
All patients that had not obtained ROSC. ETCO2 <2% (15mmHg)
(Bhende )

10. Key data from key studies
Four animal studies including immature dogs and piglets show that
1 min CPR: ETCO2 28mmHg ROSC vs 18mmHg non ROSC
(ETT clamped: Time to arrest ?: Arrest time 10 minutes before CPR: Infrared Capnometer) (Berg )
In an immature asphyxial dog model, the ETCO2 rose from a mean of 13.9mmHg to a mean of 27.0mmHg at or just prior to ROSC (ETT clamped: “Few minutes” to arrest: Arrest time 5-10 minutes before CPR: Infrared Capnometer/Easy-Cap) (Bhende 1995, 365; Bhende 1996, 349)
In asphyxia piglet model, an ETCO2 of >14mmHg had a sensitivity of 93% and specificity of 81% of HR > (Vent rate : Time to arrest 48m: CPR started at asystole: Capnometer) (Chalak )

11. Evidence profile table(s)

12. Proposed Consensus on Science statements
Five small observational studies (including four animal studies) were identified that assessed the end tidal CO2 levels associated with the onset or presence of ROSC.
We did not identify any evidence to address the critical outcomes of:
Improved perfusion
Decreased hands off time
Decreased time to ROSC
Increased survival rates
Improved neurological outcomes

13. Draft Treatment Recommendations
In asystolic/bradycardic neonates we suggest against the routine reliance on any single feedback device such as ETCO2 monitors or pulse oximeters until more evidence becomes available
(weak recommendation, very low quality of evidence).

14. Knowledge Gaps (eg. ETT vs BVM)
Other specific worksheets that would be helpful
Relationship with training to ETT success
Specific research required
Adult ETT vs BVM
Essential slide (one slide only). Estimated time <30 sec

15. Next Steps
This slide will be completed during Task Force Discussion (not EvRev) and should include:
Consideration of interim statement
Person responsible
Due date
Essential slide (one slide only). Estimated time <30 sec