Cardiopulmonary resuscitation in the newborn intensive care unit

Objectives: To determine the outcome for cardiopulmonary resuscitation (CPR ) following cardiac arrest, and the predictors of response to CPR, in newbo rn infants with a diverse range of medical, surgical and cardiological prob lems cared for in a tertiary level newborn intensive care unit (NICU). Methodology: Infants who had suffered a cardiac arrest and received CPR wer e identified by retrospective review of the NICU medical records. Results: Thirty-five (1%) of 3624 infants admitted to the NICU during a six -year period received CPR because of a cardiac arrest. Twenty (57%) of the infants did not respond to CPR and died within 2.5 h (non-responders), eigh t (23%) responded to CPR but died before discharge from hospital (short-ter m responders), and seven (20%) responded to CPR and were discharged from ho spital (long-term responders). The arterial pH was significantly lower in n on-responders to CPR compared with responders. Non-responders to CPR were n ot significantly different from responders with regard to gestational age, birth weight, age at arrest, systolic blood pressure, blood gases, severity of respiratory failure, or renal function. In 24 infants (68%), the precip itating cause for the cardiac arrest was either irreversible (20), or not k nown (4) and all died prior to discharge from hospital. In 11 infants (32%) , the cardiac arrest was considered to have been precipitated by an acute a nd reversible event, and seven (64%) survived to discharge from hospital, A ll six infants with septicaemic shock were non-responders to CPR. Three of 15 infants with complex congenital heart disease were long-term responders to CPR but none survived without a major physical and psychomotor disabilit y. Conclusion: The present study offers support for the recommendation that CP R may be withheld in infants who do not have a reversible cause for their c ardiac arrest but are dying or will die soon from the inexorable progress o f their illness.