Neonatal Resuscitation Guide : - Cardiopulmonary Resuscitation (CPR) | EHC

Perform chest compressions with two fingers at a depth of 4 cm, at a rate of 100–120/min.
If two rescuers: 15 compressions followed by 2 breaths; if alone: 30 compressions followed by 2 breaths.

Use a laryngeal mask airway (LMA) or small endotracheal tube, confirming placement via CO₂ monitoring or auscultation.

Staff Education and Preparedness for Neonatal Emergencies:

All hospital staff must be familiar with neonatal emergency recognition.
All staff should know how to activate Code Blue.
All staff trained in Basic Life Support (BLS).
Code Blue pediatric team must have successfully completed BLS, PALS, and ACLS.
The quality and training departments coordinate simulations to ensure rapid response.

Code Blue Activation Locations:

Active: inpatient wards, non-medical and medical departments (e.g., sterilization, radiology)
Silent: intensive care units, nurseries

Code Blue Pediatric Team Composition:

Team Member	Tasks and Responsibilities
Team Leader (Pediatrician/Attending Physician)	- Manages the entire resuscitation process to ensure effective and efficient execution. - Coordinates interventions such as administering defibrillation, inserting an endotracheal tube, and giving medications. - Assesses the patient’s condition. - Requests assistance or additional investigations if needed. - Organizes post-resuscitation care and ensures proper documentation of all procedures.
Nursing Team	- Tasks are assigned by the team leader as follows: • One nurse provides ventilation while another performs chest compressions. • One nurse records all steps and notes observations. • One nurse inserts and manages IV lines. • One nurse handles the crash cart and operates the defibrillator. • Participates in documenting the Code Blue report.
Attending Physician	- Provides detailed information about the patient’s medical condition. - Reviews the patient’s file and informs the team leader of any critical information. - Assists in performing chest compressions and advanced CPR as needed.
Anesthesiologist (if required)	- Manages the airway and performs endotracheal intubation. - Establishes IV access if standard attempts are unsuccessful.

Other Personnel Not Included in the Core Team:

Security Officer: Responsible for managing crowd control, clearing the area except for the Code Blue team, securing the patient’s belongings, and accompanying the deceased to the morgue while confirming the identity of the deceased.

Mechanism for Activating Staff Response (Including Emergency Code):

The first responder calls loudly for help and activates Code Blue, stays with the patient, ensures the safety of the surroundings, and begins basic CPR.
The assisting staff member contacts the switchboard number announced to all staff to activate the Code Blue alert and assists the first responder with basic CPR until the team arrives.
The responsible staff announces the Code Blue, specifies the location and department, and repeats three times clearly and loudly.

Response Timeframe:

Response must be immediate, as cardiac arrest can lead to death within minutes if resuscitation is not started promptly. The Code Blue team should reach the designated location within 3 minutes.

24/7 Unified Response:

The Code Blue team responds around the clock, 24 hours a day, 7 days a week.
Heads of relevant departments (e.g., ICU) prepare monthly Code Blue schedules, reviewed by the medical director.
The nursing administration prepares monthly staff rotation schedules for the response teams.

Documentation and Handling of Medical Emergencies & Cardiac Arrest:

Documentation of Response:

The nurse responsible for recording provides a summary of events to the nurse tasked with writing the Code Blue report, or records it herself.
The team leader completes the form and performs an audit on recorded data and procedures performed.
The form is submitted to the relevant unit supervisor.
The unit supervisor sends it to the Quality Department for review and places a copy in the patient’s file.
The Quality Department monitors all Code Blue events and reports them to improve performance.

Handling Medical Emergencies and Cardiac Arrest:

If the patient is away from a medical service area (e.g., parking lot, rooftop, sterilization, laundry, kitchen), the designated Code Blue team responds with mobile resuscitation equipment (emergency bag).
Emergency carts are strategically distributed throughout the hospital.

Emergency Bag Deployment in the Hospital:

If the patient is in a medical service area, advanced cardiac life support (ACLS) begins immediately upon Code Blue team arrival.
The team starts advanced CPR, connects the patient to 100% oxygen, monitor, and ECG machine.
All team members are fully aware of the locations of emergency carts.
Emergency carts must be accessible, fully stocked for both children and adults, and ready for immediate use.
One team member retrieves the emergency cart from the designated location under supervision.
Each Code Blue member knows their assigned role as delegated by the team leader.
The team leader decides on the use of the defibrillator based on the patient’s condition.
The team continues resuscitation until the leader decides to terminate.
The attending physician informs the patient’s family about condition changes and outcomes.
After CPR completion, the emergency cart is checked and restocked according to the hospital’s emergency supply policy.

Neonatal Resuscitation Guide