Intestinal perfusion assessed by quantitative fluorescence angiography in piglets with necrotizing enterocolitis.

BACKGROUND: Reduced intestinal perfusion is thought to be a part of the pathogenesis in necrotizing enterocolitis (NEC). This study aims to evaluate the intestinal perfusion assessment in NEC-lesions by quantitative fluorescence angiography with indocyanine green (q-ICG) during laparoscopy and open surgery. METHODS: Thirty-four premature piglets were delivered by cesarean section and fed with parenteral nutrition and increasing infant formula volumes to induce NEC. During surgery, macroscopic NEC-lesions were evaluated using a validated macroscopic scoring system (1-6 for increasing NEC severity). The intestinal perfusion was assessed by q-ICG and quantified with a validated pixel intensity computer algorithm. RESULTS: Significantly higher perfusion values were found in healthy areas of the colon (score 1) compared to those with NEC scores of 4, 5, and 6 (p < 0.05). Similarly, in the small intestine, perfusion was higher in the intestine with areas scored 1 compared to scores of 3 and 4 (p < 0.05). A cut-off value was found between NEC score of 1-2 vs. 3-4 for the small intestine at 117 and for colon at 107 between NEC scores 12 vs. scores of 36 with an area less than the curve value at 0.9 (p < 0.05). CONCLUSIONS: q-ICG seems to be a feasible and valuable technique to evaluate the perfusion of tissue with NEC-lesions. We found a cut-off between intestine with scores 1-2 and intestine with NEC scores 3-6 in colon, and NEC score 3-4 in the small intestine. LEVEL OF EVIDENCE: II.

[Paediatric Life Support]. / Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS): Leitlinien des European Resuscitation Council 2021.

The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.

European Resuscitation Council Guidelines 2021: Paediatric Life Support.

These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.

Anesthesiologists' airway management expertise: Identifying subjective and objective knowledge gaps.

BACKGROUND: Failure in airway management continues to cause preventable patient harm, and the recommended continuing education is challenged by anesthesiologists' unknown knowledge gaps. This study aimed to identify anesthesiologists' subjective and objective knowledge gaps as well as areas where anesthesiologists are incorrect and unaware. METHODS: An adaptive E-learning program with 103 questions on adult airway management was used for subjective and objective assessment of anesthesiologists' knowledge. All anesthesiologists in the Capital Region of Denmark were invited to participate. RESULTS: The response rate was 67% (191/285). For preoperative planning, participants stated low confidence (subjective assessment) regarding predictors of difficult airway management in particular (69.1%-79.1%). Test scores (objective assessment) were lowest for obstructive sleep apnea as a predictor of difficult airway management (28.8% correct), with participants being incorrect and unaware in 33.5% of the answers. For optimization of basic techniques, the lowest confidence ratings related to patient positioning and prediction of difficulties (57.4%-83.2%), which agreed with the lowest test scores. Concerning advanced techniques, videolaryngoscopy prompted the lowest confidence (72.4%-85.9%), while emergency cricothyrotomy resulted in the lowest test scores (47.4%-67.8%). Subjective and objective assessments correlated and lower confidence was associated with lower test scores: preoperative planning [r = -.58, P < .001], optimization of basic techniques [r = -.58, P = .002], and advanced techniques [r = -.71, P < .001]. CONCLUSION: We identified knowledge gaps in important areas of adult airway management with differing findings from the subjective and objective assessments. This underlines the importance of objective assessment to guide continuing education.

Suport vital pediàtric bàsic I avançat. Recomanacions per a la covid-19 del Consell Europeu de Ressuscitació (ERC) / Soporte vital pediátrico básico y avanzado. Recomendaciones para la Covid-19 del Consejo Europeo de Reanimación (ERC) / Basic and advanced pediatric life support. European Resuscitation Council (ERC) Covid-19 guidelines

Suport vital pediàtric bàsic I avançat. Recomanacions per a la covid-19 del Consell Europeu de Ressuscitació (ERC) El grup de redacció de guies pediàtriques de l'ERC ha fet una adaptació «temporal» de les seves recomanacions a l'època de la covid-19. Aquestes s'han d'interpretar dins del context de cada sistema sanitari, considerant el grau de propagació de la malaltia I la seva evolució dins de cada regió, així com l'impacte general sobre els recursos disponibles. Donada l'evidència limitada, les pautes següents són principalment el resultat del consens d'experts. Es fa referència a la protecció de personal sanitari I no sanitari, al reconeixement de l'infant greument malalt, al maneig de la via aèria I la respiració de l'infant críticament malalt amb possible covid-19, al reconeixement de l'aturada cardíaca en infants I l'algoritme de suport vital bàsic, a l'obstrucció de la via aèria per cos estrany, al suport vital avançat I a l'ètica de la reanimació en infants durant la pandèmia de covid-19

El grupo de redacción de guías pediátricas de ERC ha realizado una adaptación «temporal» de sus recomendaciones en la época de la covid-19. Estas deben interpretarse dentro del contexto de cada sistema sanitario, considerando el grado de propagación de la enfermedad y su evolución dentro de esa región, así como el impacto general sobre los recursos disponibles. Dada la evidencia limitada, las siguientes pautas son principalmente el resultado del consenso de expertos. Se hace referencia a la protección de personal sanitario y no sanitario, al reconocimiento del niño gravemente enfermo, al manejo de la vía aérea y la respiración del niño críticamente enfermo con posible covid-19, al reconocimiento de la parada cardíaca en niños y al algoritmo de soporte vital básico, a la obstrucción de la vía aérea por cuerpo extraño, al soporte vital avanzado y a la ética de la reanimación en niños durante la pandemia de covid-19

The ERC paediatric guideline writing group has "temporarily" adapted their recommendations to the context of covid-19. These should be interpreted within the context of each healthcare system, considering the degree of covid-19 spread and evolving disease profile within that region, and the overall impact on available resources. Given the limited evidence, the following guidelines are mainly the result of expert consensus. Reference is made to the protection of bystanders and healthcare professionals, to the recognition of the critically ill child, to the airway and breathing management of a critically child with potential covid-19, to the recognition of cardiac arrest in children and basic life support (BLS) algorithm, foreign body airway obstruction, advanced life support (ALS), and the ethics of resuscitation in children during the covid-19 pandemic

Pharmacokinetics of an intravenous bolus dose of clonidine in children undergoing surgery.

BACKGROUND: Clonidine is used off-label in children but only limited pediatric pharmacokinetic data are available for intravenously administered clonidine. OBJECTIVES: To determine pharmacokinetic parameter estimates of clonidine in healthy children undergoing surgery and to investigate age-related differences. Furthermore, to investigate possible pharmacokinetic differences of clonidine between this group of children and a cohort with cardiac diseases. METHODS: In a randomized placebo-controlled trial (The PREVENT AGITATION trial), blood samples for clonidine pharmacokinetic analysis were collected in a proportion of the enrolled patients. Healthy children with ASA score 1-2 in the age-groups 1 to <2 years and 2-5 years were randomized for blood sampling. Clonidine was administered as a single intravenous bolus of 3 µg/kg intraoperatively. Blood samples were drawn at baseline, 5, 10, 15, 30, 60 minutes after dosing and additionally every hour until discharge from the PACU. Clonidine analysis was performed on liquid chromatography-mass spectrometry. RESULTS: Data form eighteen children were available for pharmacokinetic analysis (ASA I; male/female: 17/1; age: 1-5 years; weight 8.7-24 kg). Population parameter estimates for the 2-compartment model were similar to previous published data for children who underwent cardiac surgery. A pooled analysis including data from 59 children indicated clearance of 14.4 L h-1  70 kg-1 and volume of distribution of 192.6 L 70 kg-1 . No age-related pharmacokinetic differences and no difference in time from administration of study medication to awakening were found. Children 1 to <2 years had a shorter PACU stay than children 2-5 years (mean difference 17% 95% CI:3%-34%, P = .02). CONCLUSION: Pharmacokinetic parameter estimates were similar for children undergoing general surgery and cardiac surgery given a single dose of intravenous clonidine. These results indicated that no dose reduction is needed in children aged 1 to <2 years compared with those 2-5 years, which was supported by pharmacodynamic observations.

Laparoscopy to Assist Surgical Decisions Related to Necrotizing Enterocolitis in Preterm Neonates.

Aim of the Study: Necrotizing enterocolitis (NEC) is a devastating intestinal disease that mainly affects preterm infants. Despite advancements in neonatal care, mortality of NEC remains high and controversies exist regarding the most appropriate time for surgical intervention and challenging of diagnosing NEC. Using a pig model of NEC, we aimed to examine if laparoscopy is feasible for diagnosis of NEC. Methods: Preterm caesarean-delivered piglets (n = 42) were fed with increasing amounts of infant formula up to 5 days to induce NEC. On days 3-5, we examined the intestine by laparoscopy under general anesthesia. The bowel was examined by tilting the pigs from supine position to the left and right side. Macroscopic NEC lesions were identified and graded according to a macroscopic scoring system, then a laparotomy was performed to rule out any organ injury and missed NEC lesions. Results: Visible NEC lesions (scores 4-6) were found in 26% (11/42) of the piglets. A positive predictive value of 100% was found for laparoscopy as a diagnostic marker of NEC in both colon and the small intestine. One piglet had a higher NEC score in the small intestine found at laparotomy, than at laparoscopy, resulting in a sensitivity of 67%, and a specificity of 100% for the small intestine. Conversely, both the sensitivity and specificity for colon was 100%. Acceptable levels of agreement was found, with minimal proportional bias in both colon and the small intestine for laparoscopy and laparotomy. Ultrasound examination had a lower sensitivity of 67% and specificity of 63%. All piglets were respiratory and circulatory stable during the procedure. Conclusions: In preterm piglets, laparoscopy is a feasible tool to diagnose NEC with a high positive predictive value and a high specificity.

Improving the cost-effectiveness of laypersons' paediatric basic life support skills training: A randomised non-inferiority study.

AIM: To compare dyad (training in pairs without an instructor) with resource-intensive instructor-led training for laypersons' paediatric resuscitation skills in a non-inferiority trial and examine cost-effectiveness of the training methods. METHODS: In this randomised parallel group non-inferiority trial, 155 dyad and 175 instructor-led laypersons were trained in Basic Life Support and Foreign Body Airway Obstruction Management. Dyads were given instructional videos, hands-on exercises and provided feedback to their partner for 50 min. Instructor-led laypersons trained in groups of six for two hours. Learning were assessed in scenarios immediately after training and, subsequently, at 14 days, 1, and 3 months. Pass rates, cost-effectiveness of producing a competent layperson (passing both tests), and non-inferiority were analysed. RESULTS: Sixty-eight (45.6%) dyad and 130 (74.3%) instructor-led laypersons passed the basic life support test (p < 0.001). For Foreign Body Airway Obstruction Management 77 (54.2%) dyad and 130 (79.3%) for instructor-led laypersons passed (p < 0.001). Skills decreased over three months for both groups. Forty-two (30.4%) dyad and ninety-eight (59.8%) for instructor-led laypersons were competent after training (p < 0.001). The lower effectiveness of dyad training had reduced costs (p < 0.001). For each 10,000 USD allocated to training, dyad training would result in 71 vs. 65 competent laypersons for instructor-led training. Non-inferiority of dyad training could not be established. CONCLUSION: Instructor-led training was the most effective but also the most expensive training method, making it less cost-effective than dyad training. When the aim is to train for quantity rather than quality, dyad training would be the preferred choice of training method.

Early Postoperative 18F-FET PET/MRI for Pediatric Brain and Spinal Cord Tumors.

Complete resection is the treatment of choice for most pediatric brain tumors, but early postoperative MRI for detection of residual tumor may be misleading because of MRI signal changes caused by the operation. PET imaging with amino acid tracers in adults increases the diagnostic accuracy for brain tumors, but the literature in pediatric neurooncology is limited. A hybrid PET/MRI system is highly beneficial in children, reducing the number of scanning procedures, and this is to our knowledge the first larger study using PET/MRI in pediatric neurooncology. We evaluated if additional postoperative 18F-fluoro-ethyl-tyrosine (18F-FET) PET in children and adolescents would improve diagnostic accuracy for the detection of residual tumor as compared with MRI alone and would assist clinical management. Methods: Twenty-two patients (7 male; mean age, 9.5 y; range, 0-19 y) were included prospectively and consecutively in the study and had 27 early postoperative 18F-FET PET exams performed preferentially in a hybrid PET/MRI system (NCT03402425). Results: Using follow-up (93%) or reoperation (7%) as the reference standard, PET combined with MRI discriminated tumor from treatment effects with a lesion-based sensitivity/specificity/accuracy (95% confidence intervals) of 0.73 (0.50-1.00)/1.00 (0.74-1.00)/0.87 (0.73-1.00) compared with MRI alone: 0.80 (0.57-1.00)/0.75 (0.53-0.94)/0.77 (0.65-0.90); that is, the specificity for PET/MRI was 1.00 as compared with 0.75 for MRI alone (P = 0.13). In 11 of 27 cases (41%), results from the 18F-FET PET scans added relevant clinical information, including one scan that directly influenced clinical management because an additional residual tumor site was identified. 18F-FET uptake in reactive changes was frequent (52%), but correct interpretation was possible in all cases. Conclusion: The high specificity for detecting residual tumor suggests that supplementary 18F-FET PET is relevant in cases where reoperation for residual tumor is considered.

Intraoperative clonidine for prevention of postoperative agitation in children anaesthetised with sevoflurane (PREVENT AGITATION): a randomised, placebo-controlled, double-blind trial.

BACKGROUND: Postoperative agitation is a frequent and stressful condition for a child, their family, and their health-care providers, and prevention would be of benefit. We aimed to assess the effects of intravenous clonidine administered intraoperatively on the incidence of postoperative agitation, pain, and adverse events. METHODS: We did this randomised, placebo-controlled, double-blind trial (PREVENT AGITATION) at one tertiary-level hospital and two urban-district hospitals in Denmark. Children aged 1-5 years, with an American Society of Anesthesiologists physical classification score of 1-2, who were scheduled for anaesthesia with sevoflurane and fentanyl were randomly assigned (1:1) in blocks of ten by computer-generated centralised randomisation, stratified by age (<2 years or ≥2 years) and site, to receive either intravenous clonidine 3 µg/kg or an equal quantity of isotonic saline in identical vials, administered around 20 min before the completion of surgery. Data were collected from the postoperative care unit (24 h) and at follow-up (30 days). Our primary outcome was the proportion of patients with one or more episodes of postoperative agitation, measured every 15 min in the postoperative care unit (POCU) with the four-point Watcha scale (ie, Watcha >2). We analysed by intention to treat. The trial is registered with ClinicalTrials.gov (number NCT02361476). FINDINGS: Between January and December, 2015, of the 379 eligible children, we randomly assigned 191 to receive clonidine treatment and 188 to receive placebo; 75 were girls (20%). Nine were excluded from the primary outcome analysis because of missing data points. 46 (25%) of 187 clonidine participants compared with 86 (47%) of 183 placebo participants had one or more episodes of postoperative agitation (Watcha score >2; relative risk 0·56, 95% CI 0·43-0·73; p<0·0001). 30 (20%) of 150 boys in the clonidine group were agitated compared with 69 (47%) of 147 boys in the placebo group (0·43, 0·30-0·61; p<0·0001). The observed effect was not significant in girls. Incidence of adverse events was similar in the clonidine and placebo groups. INTERPRETATION: On the basis of our results, clonidine might be used to safely prevent postoperative agitation in boys anaesthetised with sevoflurane. FUNDING: Danish Society of Anaesthesia and Intensive Care.

Assessment of laypersons' paediatric basic life support and foreign body airway obstruction management skills: a validity study.

BACKGROUND: Standardised courses for laypeople in Paediatric Basic Life Support (PBLS) and Foreign Body Airway Obstruction Management (FBAOM) teach essential skills for the initiation of resuscitation by bystanders. Performance assessments are necessary to ensure that skills are acquired. We aimed to examine the validity of developed performance assessments and to determine credible pass/fail standards. METHODS: Validity evidence was gathered in a standardised simulated setting by testing participants with three different levels of PBLS/FBAOM experience: untrained laypersons, trained laypersons, and lifeguards. Two blinded raters assessed participants' performance. The reliability of test scores was analysed using generalizability theory, scores were compared across the three groups, and pass/fail-standards were established. RESULTS: A total of 33 participants were included. More than two raters and two cases were necessary for PBLS to achieve a reliability coefficient above 0.80, which is considered the minimally acceptable level for high-stakes certification. For FBAOM, two tests or three raters were needed. Assessment scores differed across the three groups for PBLS skills, as well as for FBAOM skills (p < 0.001). Pass levels of 74% and 55% of the maximum score for PBLS and FBAOM, respectively, were identified as the levels that best discriminated between competent and non-competent laypersons. CONCLUSIONS: Laypersons' PBLS and FBAOM skills can be assessed in a reliable and valid way in a standardised simulated setting. However, multiple raters and scenario tests are needed to ensure sufficient reliability, which raises questions regarding the feasibility of performing certification tests for laypersons who participate in short paediatric resuscitation courses.

What should be included in the assessment of laypersons' paediatric basic life support skills? Results from a Delphi consensus study.

BACKGROUND: Assessment of laypersons' Paediatric Basic Life Support (PBLS) skills is important to ensure acquisition of effective PBLS competencies. However limited evidence exists on which PBLS skills are essential for laypersons. The same challenges exist with respect to the assessment of foreign body airway obstruction management (FBAOM) skills. We aimed to establish international consensus on how to assess laypersons' PBLS and FBAOM skills. METHODS: A Delphi consensus survey was conducted. Out of a total of 84 invited experts, 28 agreed to participate. During the first Delphi round experts suggested items to assess laypersons' PBLS and FBAOM skills. In the second round, the suggested items received comments from and were rated by 26 experts (93%) on a 5-point scale (1 = not relevant to 5 = essential). Revised items were anonymously presented in a third round for comments and 23 (82%) experts completed a re-rating. Items with a score above 3 by more than 80% of the experts in the third round were included in an assessment instrument. RESULTS: In the first round, 19 and 15 items were identified to assess PBLS and FBAOM skills, respectively. The ratings and comments from the last two rounds resulted in nine and eight essential assessment items for PBLS and FBAOM skills, respectively. The PBLS items included: "Responsiveness"," Call for help", "Open airway"," Check breathing", "Rescue breaths", "Compressions", "Ventilations", "Time factor" and "Use of AED". The FBAOM items included: "Identify different stages of foreign body airway obstruction", "Identify consciousness", "Call for help", "Back blows", "Chest thrusts/abdominal thrusts according to age", "Identify loss of consciousness and change to CPR", "Assessment of breathing" and "Ventilation". DISCUSSION: For assessment of laypersons some PBLS and FBAOM skills described in guidelines are more important than others. Four out of nine of PBLS skills focus on airway and breathing skills, supporting the major importance of these skills for laypersons' resuscitation attempts. CONCLUSIONS: International consensus on how to assess laypersons' paediatric basic life support and foreign body airway obstruction management skills was established. The assessment of these skills may help to determine when laypersons have acquired competencies. TRIAL REGISTRATION: Not relevant.

Effect of clonidine to prevent agitation in children after sevoflurane anaesthesia: a randomised placebo controlled multicentre trial.

INTRODUCTION: Post-operative agitation (PA) is a common problem (20-70%) in children anaesthetised with sevoflur-ane. Clonidine is widely used off-label in children for several indications, including PA, but the current level of evidence is limited. Our aim is to investigate the impact of prophylactic intravenous (IV) clonidine administered at the end of surgery on the incidence and degree of PA. Furthermore, the pharmacokinetic profile of IV clonidine in children is not well established and our aim is to obtain pharmacokinetic data relating hereto. METHODS: This is a multicentre, randomised and blinded clinical trial in which we will be enrolling 380 children aged 1-5 years who are planned for anaesthesia with sevoflurane and fentanyl. Inclusion is based on computer-generated randomisation (1:1) and stratified by age and site. The study drug is administered IV approximately 20 min. before the expected completion of surgery (intervention: clonidine 3 µg per kg; placebo: equal quantity of saline). CONCLUSION: The primary outcome is PA measured on the Watcha scale. The secondary outcomes include post-operative pain relief and adverse effects, including a 30-day follow-up. In total, 40 children will be allocated to drug assay sampling, enabling a compartmental pharmacokinetic analysis. FUNDING: Funded by the participating departments and by two unrestricted scientific grants from the Danish Society of Anaesthesia and Intensive. TRIAL REGISTRATION: This study was approved by the Danish Health and Medicines Authority (EudraCT number 2014-001466-10), the Ethics Committee of the Capital Region of Denmark (H-2-2014-072) and registered with Clinicaltrials.gov (NCT02361476).

Home Care Providers to the Rescue: A Novel First-Responder Programme.

AIM: To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs) were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA). METHODS: We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR) and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched providers. The study was conducted in a rural district in Denmark. RESULTS: Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED. CONCLUSION: Home care providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival.

Paediatric intensive care is feasible in a neonatal department.

INTRODUCTION: Intensive care of infants below one year of age has been centralized in a paediatric intensive care unit (PICU) related to the neonatal intensive care unit (NICU) at Rigshospitalet, the University Hospital in Copenhagen in eastern Denmark (approximately 2.5 million inhabitants) since 2002. The aim of this paper was to evaluate the experiences from the PICU. MATERIAL AND METHODS: A descriptive study including data from the 01.01.2002-31.12.2010-period from all the admissions to the PICU for infants below one year of age fulfilling one of two criteria: 1) born preterm and admitted to the department after 40 weeks of gestational age or 2) born at term and admitted to the department at an age -older than 28 days. Data were registered prospectively including information on primary diagnoses at admission, the need for mechanical ventilation and the duration of mechanical ventilation. Mortality was evaluated in the three year-period 2008-2010 by use of the Paediatric Index of Mortality 2 score (PIM2 score). RESULTS: The nine-year period saw 927 admissions to the PICU and 355 infants received mechanical ventilation (median three days). The PIM2 score was 6.7% and the mortality was 6.7% in the period during which PIM2 score was registered. The incidence of mechanical ventilation due to respiratory failure was 0.74/1,000 infants born in the -region. CONCLUSION: The experience from the NICU seems to -compensate for a low volume of infants in the PICU. The -incidence of mechanically ventilated infants due to respiratory disease in eastern Denmark is relatively low. FUNDING: Not relevant. TRIAL REGISTRATION: Not relevant. The study was not registered, as it is an observational study.

Anesthetizing the obese child.

The prevalence of childhood obesity is increasing. The focus of this review is the special anesthetic considerations regarding the perioperative management of obese children. With obesity the risk of comorbidity such as asthma, obstructive sleep apnea, hypertension, and diabetes increases. The obese child has an increased risk of perioperative complications especially related to airway management and ventilation. There is a significantly increased risk of difficult mask ventilation and perioperative desaturation. Furthermore, obesity has an impact on the pharmacokinetics of most anesthetic drugs. This has important implications on how to estimate the optimal drug dose. This article offers a review of the literature on definition, prevalence and the pathophysiology of childhood obesity and provides suggestions on preanesthetic evaluation, airway management and dosage of the anesthetic drugs in these patients. The authors highlight the need of supplemental studies on various areas of the subject.

[Advanced resuscitation of adults]. / Avanceret genoplivning af voksne.

International and European Resuscitation Council (ERC) Guidelines for Resuscitation 2005 implicate major changes in resuscitation, including new universal treatment algorithms. This brief summary of Guidelines 2005 for advanced resuscitation of adult cardiac arrest victims is based upon the ERC Guidelines which also constitute the Danish Resuscitation Council's recommendations.

[Basic and advanced resuscitation of children]. / Basal og avanceret genoplivning af børn.

The ERC Guidelines 2005 regarding the resuscitation of children and neonates recommend changes in treatment algorithms. Cardiac arrest in children is most often caused or worsened by hypoxic conditions. On confirmation of cardiac arrest in a child, treatment is initiated with 5 ventilations and continued with alternating cycles of 15 chest compressions and 2 ventilations. Defibrillation of ventricular fibrillation or pulseless ventricular tachycardia is given as single 4 J per kg(-1) shock in every cycle. Rhythm or pulse is not assessed immediately after defibrillation, but first after two minutes of basic life support, i.e. before a new attempt of defibrillation.

The elimination rates of intact GIP as well as its primary metabolite, GIP 3-42, are similar in type 2 diabetic patients and healthy subjects.

UNLABELLED: The incretin hormone, glucose-dependent insulinotropic polypeptide (GIP, previously known as gastric inhibitory polypeptide), is rapidly degraded to the biologically inactive metabolite GIP (3-42) in the circulation, but little is known about the kinetics of the intact hormone and the metabolite and whether differences exist between patients with type 2 diabetes mellitus and healthy subjects. We examined eight type 2 diabetic patients (six men, two women); mean (range) age: 59 (48-69) years; BMI: 31.6 (26.0-37.7) kg/m2; HbA1C: 9.0 (8.2-13.2) %; fasting plasma glucose (FPG): 10.0 (8.3-13.2) mmol/l and 8 healthy subjects matched for age, gender and BMI. An intravenous bolus injection of GIP (7.5 nmol) was given and venous blood samples were drawn the following 45 minutes. Peak concentrations of total GIP (intact+metabolite, mean+/-SEM) and intact GIP (in brackets) were 920+/-91 (442+/-52) pmol/l in the type 2 diabetic patients and 775+/-68 (424+/-30) pmol/l in the healthy subjects (NS). GIP was eliminated rapidly with the clearance rate for intact GIP being 2.3+/-0.2 l/min in the type 2 diabetic patients and 2.4+/-0.2 l/min in the healthy subjects (NS). The volumes of distributions were similar in the two groups and ranged from 8 to 21 l per subject. The primary metabolite, GIP 3-42, generated through the action of dipeptidyl peptidase IV (DPP-IV), was eliminated with a mean half-life of 17.5 and 20.5 min in patients and healthy subjects (NS). CONCLUSION: Elimination of GIP is similar in obese type 2 diabetic patients and matched healthy subjects. Differences in elimination of GIP and its primary metabolite, therefore, do not seem to contribute to the defective insulinotropic effect of GIP in type 2 diabetes.