Resuscitation videos, and adherence to guidelines
A total of 90 newborns were resuscitated, of which 20 were judged to be adequately recorded. The excluded cases were due to: 1) The camera was shielded at the time of the resuscitation due to other patients in the same room who did not provide their consent, 2) Consent was not obtained before birth due to late presentation, labour pain, or an obstetrical emergency, 3) The resuscitation was performed in another location. 4) Technical camera issues. The remaining videos were analysed for quality of care (table 4), and timelines for each resuscitation were created (figure 2).
PPV initiation was inadequately performed in 15 cases (75%). The mean time to first ventilation was 98 seconds (10 – 416 s). Timing was started when the newborn was placed on the resuscitation table. Within the first minute of life, nine patients (45%) were ventilated and 10 (50%) were not ventilated, and in 1 case (5.0%) no PPV was performed. Suction was performed vigorously and repeatedly in 16 patients (80%), and a median time of 65 seconds (12 – 177 s) was spent suctioning. In all cases, ventilation was initiated but not sustained (or not performed at all) with breaks between efforts. On average, in the first 15 minutes or until resuscitation was ceased, no intervention was performed one-third of the time.
Of the 20 resuscitation recordings, 10 (50%) died; eight after attempting resuscitation (median time spent on resuscitation: 480 seconds (95 – 3632 seconds), and two died in the subsequent hours after initially successful resuscitation.