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Flashing Timer Results in Marked Improvement in Heart Rate Assessment During Simulated Newborn Resuscitation

Presented at the Neonatal Society 2014 Spring Meeting.

Janes R, Pereira A, Morris D, Sharkey D

Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK

Background: Heart rate (HR) at birth is the most useful measure of the need for and effectiveness of resuscitation. Initial assessment, using a stethoscope as recommended by international guidelines (1), is incorrect in approximately 30% of cases (2). Recommendations suggest counting the heart beats for 6 seconds and multiplying by 10 as an estimate of HR. However, internal calculation of time varies significantly between observers. We hypothesised a standardised 6 second flasher would increase HR accuracy during simulated newborn resuscitation.

Methods: Newborn Life Support (NLS) qualified healthcare professionals undertook simulated newborn resuscitation with heart rates randomly selected at 50, 70, 90 and 110bpm. Using a randomised crossover design, participants were randomly allocated to either calculate the HR, with a stethoscope, using their own preferred method or using a 6 second flashing timer. Accuracy (within 10bpm) and assessment time were compared between methods using appropriate parametric and non-parametric analysis. Ethical approval was granted by the University of Nottingham School of Medicine ethics committee.

Results: 44 NLS trained participants performed 440 HR assessments. HR accuracy improved significantly from 65% with their own method to 86% with the flashing timer (P<0.0001). This resulted in the difference with HR assessment using own method of 16.2bpm (95% CI 13.7-18.7) compared with 10.7bpm (95% CI 8.2-13.2) when using the timer. HR assessment time decreased significantly from 22.6s by own method to 14.7s with the timer (P<0.0001). When categorising the HR into NLS categories (HR>100, 60-100 and <60bpm) participants were incorrect using their own method 31% of the time compared to 16% with the timer (P<0.0001). When resuscitating the baby for 5 cycles of the recommended algorithm only 4 (9%) participants did this without error using their own method compared to 23 (52%) using the timer.

Conclusion: Use of a simple visual 6 second timer significantly increases accuracy of HR assessment during newborn resuscitation simulations and reduces overall time of assessment. Integration of such a timer into the stethoscope head or resuscitaire could be a simple and inexpensive method to improve newborn resuscitation.

Corresponding author: Don.sharkey@nottingham.ac.uk

1. Perlman et al, Circulation 2010;122[s2]:S516 –S538.
2. Voogdt et al, Resuscitation 2010; 81(8):1000-03.

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