Frédérique Briche

Reply to Letter: The utility of electrocardiogram for evaluation of clinical cardiac arrest in neonatal resuscitation: Promises which need confirmation☆

We have read with interest the article by Koizumi et al. that ighlights the utility of the electrocardiogram (ECG) for the evalution of clinical cardiac arrest in neonatal resuscitation.1 The tools, hich include ECG, cardiac auscultation and pulse oximetry (PO), ffer a combination whose diagnostic sensitivity and specificity eserve further accurate assessment. The authors suggest intraospital care. We present here our experience of the extra-hospital ituation. Births are frequent (N = 300 in 2015 in our backup sysem) and take place without the use of any sophisticated technical quipment. The fastest teams on site are professional first responers in 85% of cases. They await the arrival of the medical team or a median duration of 20 min, with an interquartile range of 2–30 min; their newborn evaluation tools are those that evalute the clinical condition (Apgar, pulse palpation, etc.) associated ith pulse oximetry (PO). The use of the ECG has not been tested n newborns in our system but only in young children on the utomated external defibrillator (AED) screen in situations outide any ventricular fibrillation context. Its use has led to many alse positives due to the presence of electrical activity associated ith the perception of the first responder’s own finger pulse in lace of no pulse of the victim. Such misjudgment has been the ause of many hand-offs of victims requiring chest compressions data not published). Because of this, the completion of CPR withut interruption until the arrival of the medical team is the rule of humb. Recommendations for the care of newborns are based on the act that the heart rate is initially measured more quickly and preisely by listening to heart sounds with a stethoscope (at the cardiac pex) or by ECG than by seeking a palpable pulse.2 The ECG is faster nd more accurate, especially in the first two minutes of life. The erception of a pulse at the base of the umbilicus is reliable only if t exceeds 100 pulses per min.2 Given these data, we will start a study, first, to validate the uscultation of heart sounds by the first responders and, second, o study the possibility of exploiting the variation of the thoracic