Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Arch Dis Child Fetal Neonatal Ed. 2019 Mar;104(2):F215-F217. doi: 10.1136/archdischild-2018-314907. Epub 2018 Jun 12.
The 2015 neonatal resuscitation guidelines added ECG as a recommended method of assessment of an infant's heart rate (HR) when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room.
To compare accuracy of ECG with auscultation to assess asystole in asphyxiated piglets.
Neonatal piglets had the right common carotid artery exposed and enclosed with a real-time ultrasonic flow probe and HR was continuously measured and recorded using ECG. This set-up allowed simultaneous monitoring of HR via ECG and carotid blood flow (CBF). The piglets were exposed to 30 min normocapnic alveolar hypoxia followed by asphyxia until asystole, achieved by disconnecting the ventilator and clamping the endotracheal tube. Asystole was defined as zero carotid blood flow and was compared with ECG traces and auscultation for heart sounds using a neonatal/infant stethoscope.
Overall, 54 piglets were studied with a median (IQR) duration of asphyxia of 325 (200-491) s. In 14 (26%) piglets, CBF, ECG and auscultation identified asystole. In 23 (43%) piglets, we observed no CBF and no audible heart sounds, while ECG displayed an HR ranging from 15 to 80/min. Sixteen (30%) piglets remained bradycardic (defined as HR of <100/min) after 10 min of asphyxia, identified by CBF, ECG and auscultation.
Clinicians should be aware of the potential inaccuracy of ECG assessment during asphyxia in newborn infants and should rather rely on assessment using a combination of auscultation, palpation, pulse oximetry and ECG.
2015 年新生儿复苏指南增加了心电图（ECG）作为评估婴儿心率（HR）的推荐方法，用于确定出生时是否需要复苏。然而，最近的一份病例报告对这一技术在产房中的应用提出了担忧。
比较心电图与听诊在评估窒息仔猪心动停止时的准确性。
将新生仔猪的右颈总动脉暴露出来，并包裹在实时超声血流探头中，使用 ECG 连续测量和记录 HR。该设置允许通过 ECG 和颈动脉血流（CBF）同时监测 HR。将仔猪暴露于 30 分钟的常氧肺泡低氧血症中，然后进行窒息，方法是断开呼吸机并夹住气管导管。将心动停止定义为颈动脉血流为零，并与 ECG 轨迹和使用新生儿/婴儿听诊器听诊心音进行比较。
总共对 54 头仔猪进行了研究，窒息持续时间中位数（IQR）为 325（200-491）秒。在 14 头（26%）仔猪中，CBF、ECG 和听诊可识别心动停止。在 23 头（43%）仔猪中，我们观察到没有 CBF 和听不到心音，而 ECG 显示 HR 范围在 15 到 80 次/分之间。16 头（30%）仔猪在窒息 10 分钟后仍保持心动过缓（定义为 HR<100 次/分），通过 CBF、ECG 和听诊进行了识别。
临床医生应意识到在新生儿窒息期间 ECG 评估可能不准确，而应依赖于听诊、触诊、脉搏血氧饱和度和 ECG 结合的评估。
