To summarize the intro and justification, there is a compelling argument that an anticholinergic like atropine may improve HR, but that the likely cause of bradycardia is related to hypoxemia. I believe that is clear. My only thought is whether the phrasing of the treatment recommendation sentence is too prescriptive/could be interpreted as “just never use atropine, RECOVER recommends against it.” In other words, the recommendation is more nuanced. I wonder if there is another way to relay the point but also avoid misinterpreting the recommendation. Something to the effect of “…we suggest against routine atropine administration in lieu of strategies to address hypoxemia,” or “..we suggest considering atropine administration only when bradycardia is refractory to interventions to correct hypoxemia.” I realize the recommendations should be short and sweet, but this one is hard. I fear many folks will look at the treatment recommendation and simply take away “never use atropine” as if it’s considered harmful. That of course if the responsibility of the reader to decipher, just wondering if there’s an easier way to help them decipher that. Just a thought.

Hi Carolyn, thanks for your contribution as evidence evaluator. Yes, all these boxes are based on the search strategies created by the information specialists, the summary of findings tables based on the evidence evaluators work, the worksheets that were build on the summary of findings tables, the worksheet reviews by Domain Chairs and RECOVER Co-chairs and then a consensus process including subject matter experts. Please check the respective worksheets to learn more about what each element in the algorithm is based on. For that I recommend to navigate to the overview file, so you know which PICO question concerns things such as C:V ratio and atropine. You can then navigate to the respective worksheet. There are 2 for atropine (one for treatment of bradycardia at birth and one for transitional newborns during CPR). There is also one worksheet that reviews the evidence on compression:ventilation ratio during CPR of transitional newborn puppies and kittens. To my knowledge, atropine was never advised for this population (newborns at birth), in contrast to adult CPR in dogs and cats where its use is suggested with vagal etiology of CPA.

Instead of “all of the above” perhaps “all of the preceding”?