Date Published

November 22, 2013

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: I have read the post Jan. 31 2012 in regards to R/A vs. 02 when resuscitating a neonate. It states that 100% 02 will be used after 90 sec with compressions if HR is below 60. It also states that 100% 02 will be continued until HR is normal. Does this refer to 100 bpm?

The reason I ask is if I read the flow chart to the letter at 90 sec with a HR below 60, 02 and compressions are begun. If I reassess 30 sec later and the HR has improved above 60 but below 100 (ex. 80 bpm), I continue ventilating, but do I discontinue the 02 and use R/A only? Also compressions are to be discontinued. What is stance on using a pedi-mate on a critical or VSA neonate or child (below 40 lbs)? Is it necessary as it can be cumbersome and time consuming when trying to get off scene quickly?


 Great question. Our recommendation is that once the decision has been made to begin providing 100% oxygen, paramedics are not to return to room air ventilation.

That being said, we do see on the flow chart in your medical directive the area to which you are referring. It indicates (next to the "90 secs" section) that if the HR returns to above 60bpm then paramedics are to return to ventilations and this "bubble" states room air.

The 2010 AHA Guidelines (Kattwinkel et al Part 15: Neonatal Resuscitation Circulation Nov 2010) states:

"If the baby is bradycardic (HR < 60 per minute) after 90 seconds of resuscitation with a lower concentration of oxygen, oxygen concentration should be increased to 100% until recovery of a normal heart rate (Class IIb, LOE B)."

Our interpretation of this "recovery of a normal heart rate" would be a heart rate which is greater or equal to 100 bpm to then begin "supportive care" which is noted on the far right of the flow chart in your medical directive. In terms of the pedi-mate, paramedics are governed under the BLS Patient Care Standards and service policies in regards to securing patients. That being said paramedics also make life and death decisions all of the time including the use of rapid extrication techniques, where the circumstances require quicker action perhaps because of a patient safety issue, or environmental concern. In leading such a situation in a pediatric arrest, stress levels can be high, and the rapid patient movement has to be balanced against dropping or injuring of a patient in a stressful situation. We know from our military paramedics, that equipment had to be changed to allow easier opening and access due to the loss of fine motor dexterity at high heart rates in the treating combat medics. Neonatal, and child VSAs, can certainly have bad outcomes, and they are hard on us all, but not securing a child safely in your care with a consequent possible injury, would be tragic.



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