Neonatal chest compressions: indications, technique, and reassessment
THE CONTEXT
Chest compressions mechanically circulate blood to vital organs when neonatal hypoxia causes slowing of the heart rate and reduced myocardial contractility.
Purpose and indication
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Hypoxia slows the heart rate and reduces myocardial contractility, diminishing blood and oxygen delivery to vital organs.
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Rhythmic sternal compression compresses the heart against the spine and increases intrathoracic pressure to circulate blood.
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Bag-mask ventilation must accompany chest compressions so that oxygenated blood is circulated.
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Start chest compressions if the heart rate remains below 60/min after 30 seconds of positive pressure ventilation.
Technique and precautions
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Use the two-thumb technique: depress the sternum with both thumbs while the hands encircle the torso and the fingers support the back. The previously used two-finger technique is no longer recommended.
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Apply pressure over the lower third of the sternum, just above the xiphisternum, and avoid force on the xiphoid.
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Keep the thumbs in contact with the chest during both compression and release.
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Potential complications include broken ribs, liver lacerations, and pneumothorax.
Coordination and reassessment
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Give one positive pressure breath after every third compression: 90 compressions and 30 ventilations per minute, totaling 120 events.
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Deliver three compressions over 1½ seconds and allow ½ second for ventilation.
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Check femoral or carotid pulsation periodically to assess compression efficacy.
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Recheck the heart rate after 60 seconds of compressions. If it remains below 60/min, continue compressions and positive pressure ventilation; epinephrine may be required.
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If the heart rate is 60/min or above, discontinue compressions. Continue positive pressure ventilation until the heart rate exceeds 100/min and spontaneous breathing is present.