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Arch Dis Child Fetal Neonatal Ed. 2019 Feb 22. pii: fetalneonatal-2018-316087. doi: 10.1136/archdischild-2018-316087. [Epub ahead of print]

Cardiac arrest with pulseless electrical activity rhythm in newborn infants: a case series.

Author information

Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Department of Neonatology, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada.
Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.
Department of Neonatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada.
Department of Neonatology, Royal Alexandra Hospital, Edmonoton, Alberta, Canada.


The 2015 neonatal resuscitation guidelines added ECG to assess an infant's heart rate when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room. We report four cases of pulseless electrical activity during neonatal cardiopulmonary resuscitation in levels II-III neonatal intensive care units in Canada (Edmonton [n=3] and Winnipeg [n=1]).Healthcare providers should be aware that pulseless electrical activity can occur in newborn infants during cardiopulmonary resuscitation. We propose an adapted neonatal resuscitation algorithm to include pulseless electrical activity. Furthermore, in compromised newborns, heart rate should be assessed using a combination of methods/techniques to ensure accurate heart rate assessment. When ECG displays a heart rate but the infant is unresponsive, pulseless electrical activity should be suspected and chest compression should be started.


asphyxia; cardiac arrest; infants; neonatal resuscitation; newborn; pulseless electrical activity

Conflict of interest statement

Competing interests: None declared.

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