PC2051: A Simulation-based Comparison of Digital Stethoscope with Electrocardiography and Standard Stethoscope in Heart Rate Assessment During Neonatal Resuscitation

Background: Current Neonatal resuscitation program (NRP) guidelines recommend the use of umbilical cord palpation, auscultation, pulse oximetry, and electrocardiography (ECG) for Heart Rate (HR) assessment during neonatal resuscitation. But the accuracy, timeliness, and reliability of these methods are debatable, with each having its own set of advantages and limitations. Digital stethoscopes have gained popularity in pediatric and adult settings but have not been evaluated in neonatology. This experiment was aimed at comparing three methods of HR assessment in a simulation environment: using a standard stethoscope (method a), using chest leads and a standard stethoscope (method b) and using a digital stethoscope wired to a speaker which transmits the heart sounds out loud (method c).

Methods: Data were collected from the simulated neonatal resuscitation performed by NRP-certified providers as their periodic practice drills. The high-fidelity mannequin's HR, respiration and pulse oximeter was controlled wirelessly by a designated person (mannequin controller) who documented the timing of actual HR changes to compare with the resuscitation documentation. Each team, comprising a neonatologist, a nurse and a respiratory therapist, performed three scenarios using the three methods (a, b and c, described above). Six separate teams (18 providers) performed the three scenarios in a different sequence. The same recorder documented the proceedings on a standard hospital-based documentation sheet. The documentation was analyzed, and timings were noted for analysis by two neonatologists who were blinded to the method of HR monitoring.

Results: A total of 18 scenarios were completed (6X3). The timing of the first heart rate measurement, the start of positive pressure ventilation (PPV), and the total number of HR recordings were documented for all 18 scenarios. HR rise/drop was recorded in all scenarios except for four (2 for standard stethoscope and 2 for digital stethoscope). The time gap between the actual drop or rise in heart rate reported by the mannequin controller and the resuscitation documentation was compared. The team using a digital stethoscope was the fastest to record the first HR, the quickest to recognize an HR drop/rise and documented the maximum number of HR readings (Table 1). In an informal discussion, the stethoscope also received positive feedback from most team members for their ability to listen to the heart sounds aloud.

Conclusion: A digital stethoscope wired to the speaker performed better than the other methods of HR assessment during simulated neonatal resuscitation. The initial difficulty in putting on limb leads and inconsistent communication with a single provider auscultating the HR during resuscitation are possible reasons for the difference. However, further human studies are needed to elucidate the usefulness of digital stethoscopes in neonatal resuscitation.