Back versus chest ECG electrode placement: Preset back ECG electrodes promising in neonates requiring advanced resuscitation

The recent Neonatal Resuscitation Program recommends the early utilization of an ECG (electrocardiogram) for non-vigorous newborns in the delivery room. However, placing ECG electrodes on the chest may delay obtaining a reliable heart rate and could interfere with chest compressions. A previous study showed that preset ECG electrodes are quicker than a pulse oximeter (POX) for heart rate detection.

Rashmi Gulati, University of South Alabama Children’s and Women’s Hospital, AL, USA, and colleagues aimed to compare time to detect a reliable HR using back-placed ECG electrodes versus standard front placement.

For the study, infants were randomly assigned to back (n = 85) or chest (n = 89) electrode placement. Time measurement began upon placing infants on a Panda warmer ResusView. Failure was defined as no heart rate detected within 5 minutes. The intention-to-treat analysis compared HR signal acquisition time between groups.

Based on the study, the researchers reported the following findings:

· Both groups showed similar proportions of detectable HR within the first minute.

· Median time to obtain HR was 26 seconds for the chest group and 21 seconds for the back group.

· A large number of vigorous infants were included. In the chest group, these vigorous infants had shorter HR acquisition times than non-vigorous infants (Mean ± SD of 34 ± 48 seconds vs. 50 ± 44 seconds respectively).

· Failure rates and time to acquire an HR for infants who were non-vigorous and required advanced resuscitation were similar between the back and chest groups.

"Preset back ECG electrodes have shown encouraging results in neonates requiring advanced resuscitation," the researchers wrote. "There is a need for further studies to enhance guidance during neonatal resuscitation."

Reference:

Gulati R, Sayegh L, McCurley C, Eyal F, Zayek M. Back vs. chest ECG electrode placement in neonatal resuscitation: A pilot randomized controlled trial. Resuscitation. 2023 Nov;192:109961. doi 10.1016/j.resuscitation.2023.109961. Epub 2023 Sep 9. PMID: 37678627.