Reply letter to: Intubation in neonatal resuscitation — Compelling necessity or incalculable risk?

Schwindt et al., raise concerns about a passage in the algorithm of latest European Resuscitation Council (ERC) newborn life support (NLS) guidance. The authors are worried that ERC-NLS recommendation to “Consider intubation if not done already (or laryngeal mask possible)” may be interpreted as an imperative intubate when commencing chest compressions (CC). They speculate this would delay delivering effective ventilation and ongoing management put patients at risk. We disagree with their interpretation group unanimously refutes notion guideline mandates CC. It asks those involved think whether or (LM) might beneficial time, bearing mind babies who receive CC will have received been suboptimal is then potentially further compromised by delivery CC.1Huynh T. Hemway R.J. Perlman J.M. Assessment face during synchronised compressions.Arch Dis Child Fetal Neonatal Ed. 2015; 100: F39-F42Crossref PubMed Scopus (8) Google Scholar, 2Boldingh A.M. Skåre C. Nakstad B. Solevåg A.L. Suboptimal heart rate assessment airway infants receiving room compressions: quality assurance project.Arch 2020; 105: 545-549Crossref (3) Scholar Therefore, writing concluded secure was optimal insertion LM) could undertaken competently safely, it should considered. guidelines prescriptive individual teams choose most means according locally available skills facilities, mask, LM, intubation. appreciate efforts aiming improve resuscitation basing them on evidence. However, needs acknowledged studying very challenging cases infrequent, heterogenous difficult anticipate, meaning solid evidence scarce no good studies exist newborns CPR. With respect effectiveness invasive versus non-invasive management, recognises few in-vivo observations many in-vitro which highlight plethora problems facemask ventilation, like leak obstruction, fact resuscitators neither able accurately assess nor rate.3Schilleman K. van der Pot C.J. Hooper S.B. Lopriore E. Walther F.J. te Pas A.B. Evaluating manual inflations breathing preterm birth.J Pediatr. 2013; 162: 457-463Abstract Full Text PDF (65) 4Poulton D.A. Schmölzer G.M. Morley Davis P.G. rise room.Resuscitation. 2010; 82: 175-179Abstract (97) 5Yamada N.K. Yaeger K.A. Halamek L.P. Analysis classification errors made neonatal resuscitation.Resuscitation. 96: 109-113Abstract (36) Further, we agree acknowledging adequate thus oxygenation, take precedence over all other resuscitative measures majority requiring questions al. ask, consider one, two four highly-challenging answer clinical studies. Question three suggesting prioritises tasks. That incorrect: ‘consider’ makes judgements priorities but ensure remains priority — rather than making invalid assumption continuing vascular access drugs inappropriately. In absence superior CPR CC, suggest commonly poorly performed, remain our LM airways faced None has financial relationships relevant review. conflicts interest All contributed letter. wish acknowledge collaboration following authors: 2021 group: Sean Ainsworthf, Hege Ersdalg,h, Mario Rüdigeri,j, Christiane Skårek, Tomasz Szczapal, Arjan Pasm, Daniele Trevisanuton, Berndt Urlesbergero, Dominic Wilkinsonp,q,r, Jonathan P. Wyllies Collaborators affiliations: fDirectorate Women’s Children’s Services, Victoria Hospital, Kirkcaldy, UK gDepartment Anaesthesiology Intensive Care, Stavanger University Stavanger, Norway hFaculty Health Sciences, iDepartment for Neonatology Pediatric Care Medicine, Clinic Pediatrics, Hospital C.G. Carus, Technische Universität Dresden, Germany jCenter Feto-Neonatal Health, kDepartment Anaesthesiology, Oslo lDepartment Neonatology, Biophysical Monitoring Cardiopulmonary Therapies Research Unit, Poznan Medical Poznan, Poland mDepartment Paediatrics, Division Leiden Center, Leiden, Netherlands nDepartment Woman’s Child’s Padova, Italy oDivision Graz, Austria pOxford Uehiro Centre Practical Ethics, Faculty Philosophy, Oxford, qNewborn John Radcliffe Oxford Hospitals, rMurdoch Institute, Melbourne, Australia sJames Cook Middlesbrough, UK. Intubation Compelling necessity incalculable risk?ResuscitationVol. 165PreviewIn recent years, emergency adult pediatric declined since does appear patient outcome and, fact, detrimental effects. This also reflected Adult Paediatric Advanced Life Support Courses (ALS EPALS), where much more attention being paid focusing, example, sufficient ventilation. Full-Text