NRP vs PALS the great debate

strive to revive
Molly Ball, MD Richard Fernandez, MD
NICU CTICU

NRP instructor update:

• “Although scenarios encountered outside of the delivery room may
be different from the events in the immediate post-delivery period,
the physiologic principles remain the same throughout the neonatal
period.”
• “The priority for resuscitating babies at any time during the newborn
period, regardless of location, should be to restore adequate
ventilation…”

AHA, AAP NRP Instructor Update. Vol 21 No 2 Fall/Winter 2012

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NRP Resuscitation Algorithm

Jeffrey M. Perlman et al. Circulation. 2015;132:S204-S241

Copyright © American Heart Association, Inc. All rights reserved.

PALS
Algorithms

Monica E. Kleinman et al. Circulation. 2010;122:S876-S908

Copyright © American Heart Association, Inc. All rights reserved.

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 Differences between NRP and PALS for infant CPR
NRP PALS
Compression: Ventilation Ratio 3:1 coordinated 30:2 coordinated (single rescuer)
15:2 coordinated (2 rescuer)
Compression: Ventilation Ratio 3:1 coordinated 100 compressions/min and 8-10
*with advanced airway breaths/minute, not coordinated
Heart Rate checks Q 45-60 sec Q 2 min

Pathologic Rhythm Addressed Bradycardia Bradyarrhythmia/Tachyarrhythmia

Asystole Asystole
PEA
V-Fib/pulseless V-tach
Access Resuscitation UVC IV
IO
Medications Epinepherine Adenosine, amiodarone, atropine,
calcium chloride, epinephrine, glucose,
lidocaine, naloxone, magnesium
sulfate, procainamide, bicarbonate
Adapted from T Sawyer et al. Infant resuscitation outside the delivery room in neonatal-perinatal and pediatric critical
care fellowship programs: NRP or PALS? Results of a national survey. J of Neonatal Perinatal Medicine. 2 (2009) 95-102.

• Thanks!