P0373 - A survey of academic neonatologists on neonatal cardioversion and defibrillation

Background: Atrial flutter and life-threatening ventricular arrhythmias are rare in neonates1. Atrial flutter may require cardioversion while ventricular tachycardia may deteriorate into pulseless cardiac arrest requiring defibrillation. Neonatologists are trained in Neonatal Resuscitation Program (NRP) that does not include training on cardioversion or defibrillation. This study surveyed neonatologists on their experiences and comfort with cardioversions and defibrillation.

Methods: The project was approved by the human research protection office at the University of Missouri in Columbia, Missouri. We distributed an electronic survery on the software REDCap® ( hosted by MU) based survey to academic neonatologists affiliated with 12 academic centers in the Midwest.

Results: An electronic survey on RedCap® was sent via email to 180 neonatologists in the Midwest. 72 out of 180 ( 40 %) responded. 52 (72%) have been practicing for more than 5 years. 2 (2.8%) of them were trained in a medicine-pediatrics combined residency and 5 (6.9%) had prior training in a different country. While nearly all of them (98.6 %) maintained current NRP certification, only 39 (54.2 %) had current Basic Life Support (BLS) certification, 27 (37.5%) had current Pediatric Advanced Life Support (PALS) certification and 5 (6.9%) had Advanced Cardiac Life Support (ACLS) certification. 53 (73.6%) reported performing cardioversion or defibrillation on a neonate in the NICU or the delivery room, with most of them (84.9%) performing 3 or less and only 1 neonatologist performing more than 5 such procedures. Two-thirds of them performed such procedures within the past 5 years. A majority of them (52.8%) did not have a pediatric cardiologist by the bedside at the time of performing cardioversion or defibrillation. While 6 respondents (11.3 %) were very uncomfortable and 21 (39.6%) were slightly uncomfortable performing cardioversion of defibrillation, 14 (26.4%) were slightly comfortable and 12 (22.6%) were very comfortable with such procedures. 4 respondents suggested that arrhythmia and cardioversion/defibrillation simulations should be offered in order to develop and maintain skills.

Conclusions: A majority of attending neonatologists have performed neonatal cardioversion or defibrillation. NRP does not include training on these procedures and most neonatologists are not certified in PALS. Some respondents desired more simulation based learning of these low frequency high impact events. Simulations focused on recognition of cardiac arrhythmias and cardioversions and defibrillations should be offered regularly to academic neonatologists.

1. El Joueid N, Touma Boulos M, Abou Jaoude S, Daou L. Ventricular Tachycardia in an Infant Without Congenital Anomaly: A Case Report. Cardiol Res. 2020;11(1):61-65.