In November 2017, the American Heart Association updated the pediatric basic life support and cardiopulmonary resuscitation (CPR) quality. The new guidelines focused on the clinical value of chest compression-only CPR versus CPR using chest compressions with rescue breaths in children, rather than a comprehensive revision of the 2015 edition guidelines. The Pediatric Task Force of the International Liaison Committee on Resuscitation updated part content of the guidelines according to the continuous evidence review process. Guidelines recommend CPR using chest compressions with rescue breaths should be provided for infants and children with cardiac arrest. Bystanders provide chest compressions if they are unwilling or unable to deliver rescue breaths. This article mainly interprets the updated content.
In November 2018, the American Heart Association (AHA) updated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Rather than a comprehensive revision of the 2015 edition guidelines, the 2018 AHA guidelines update was updated again according to the rule " the update of the guideline is whenever new evidence is available”, providing the evidence review and treatment recommendation for antiarrhythmic drug therapy in pediatric shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. The Pediatric Task Force of the International Liaison Committee on Resuscitation updated the guideline, reaffirming the 2015 pediatric advanced life support guideline recommendation that either lidocaine or amiodarone may be used to treat pediatric patients with shock-refractory ventricular fibrillation or pulseless ventricular tachycardia.
In November 2019, the American Heart Association updated guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care. This update is not a comprehensive revision of the 2015 version. The updates for children and newborns mainly include three aspects: ① Pediatric basic life support: A. It is recommended that emergency medical dispatch centers offer dispatcher-assisted CPR instructions for presumed pediatric cardiac arrest. B. It is recommended that emergency dispatchers provide CPR instructions for pediatric cardiac arrest when no bystander CPR is in progress. ② Pediatric advanced life support: A. The bag-mask ventilation is reasonable compared with advanced airway interventions (endotracheal intubation or supraglottic airway) in the management of children during out-of-hospital cardiac arrest (OHCA). B. The extracorporeal CPR may be considered for pediatric patients with cardiac diagnoses who have in-hospital cardiac arrest (IHCA) in settings with existing extracorporeal membrane oxygenation protocols, expertise, and equipment. C. Continuous measurement of core temperature during targeted temperature management is recommended; for infants or children between 24 hours and 18 years of age who remain comatose after OHCA or IHCA, targeted temperature management is recommened. ③ Neonatal resuscitation: A. In term and late-preterm newborns (≥35 weeks of gestation) receiving respiratory support at birth, the initial use of 21% oxygen is reasonable. B. One hundred percent oxygen should not be used to initiate resuscitation because it is associated with excess mortality. C. In preterm newborns (<35 weeks of gestation) receiving respiratory support at birth, it may be reasonable to begin with 21% to 30% oxygen.
In October 2020, the American Heart Association issued the 2020 edition of guidelines for cardiopulmonary resuscitation and cardiovascular first aid, which comprehensively revised cardiopulmonary resuscitation and emergency cardiovascular care guidelines related to adults, children, newborns, resuscitation education science and treatment system. According to the latest edition of International Liaison Committee on Resuscitation’s classes of recommendation and levels of evidence, relevant suggestions are put forward. This article interprets the main updated and revised content, including children’s basic and advanced life support and neonatal resuscitation, in order to better guide emergency personnel and improve the quality of cardiopulmonary resuscitation and cardiovascular first aid.
ObjectiveTo investigate the effect of dexamethasone on mammalian target of rapamycin (mTOR) expression of astrocytes in hippocampus of rats with sepsis associated encephalopathy (SAE). MethodsTotally, 90 cases of 30-day-old male Wistar rats were randomly divided into sham-operation group (n=10) and cecal ligation and puncture (CLP) group (n=80). Models of rats with sepsis were established by CLP. At 12 hours after CLP, if rats appeared lower neurobehavioral scores, abnormal electroencephalogram (EEG) and somatosensory evoked potential (SEP), they were diagnosed with SAE. And then, they were randomly divided into non-treated group and dexamethasone group. Rats in the dexamethasone group were injected with dexamethasone (1 mg/kg) via tail vein every other day for a total of 3 times. The same dose of saline was used in the non-treated group. The neurobehavioral score was measured, SEP and EEG were examined in the age of 40 days, and then the rats were killed and the hippocampus was taken. Expressions of mTOR protein were measured by Western blot. The glial fibrillary acidic protein (GFAP) and mTOR were detected by immunofluorescence assay, and the number of positive cells was calculated by image analysis system software. ResultsSix of 80 CLP rats died in 12 hours after operation, and 28 of 74 rats were diagnosed as SAE because they appeared lower neurobehavioral scores, abnormal EEG and SEP at 12 hours after CLP. The incidence of SAE was 37.84% (28/74). In the age of 40 days, compared with non-treated group, neurobehavioral score of rats in the dexamethasone group was low, the amount of alpha waves in EEG reduced, delta waves increased, the amplitude of P1 waves in SEP was decreased, and the latencies of P1 and N1 waves were prolonged (P＜0.05). GFAP immunofluorescence staining showed astrocytic body and processes were small in the sham operation group. However, astrocytes in the non-treated group had large body and hypertrophic processes, and compared with the sham operation group, the number of these cells increased significantly (P＜0.05). Astrocytic body and processes were small in the dexamethasone group compared with the non-treated group, and the number of cells also decreased (P＜0.05). The mTOR positive astrocytes in the non-treated group were more than those in the sham operation group (P＜0.05). But mTOR positive astrocytes in the dexamethasone group were fewer than those in the non-treated group (P＜0.05). ConclusionsAstrocytes are activated in the hippocampus of rats with SAE. They show features of reactive hyperplasia, and the expression of mTOR is up-regulated, while dexamethasone can inhibit effects on these.
As a global accidental injury, drowning has a huge spiritual and economic impact on patients, families and society. In order to improve the quality of pre-hospital and in-hospital emergency treatment of drowning, improve the prognosis, improve survival rate, and reduce the burden of drowning, in 2016, the Wilderness Medical Society drafted practice guidelines related to drowning. The first update of this guide was released in June 2019. The updated guide covers the terms of drowning, rescue and resuscitation, emergency treatment, preventive measures and other aspects. This article interprets the updated guidelines in order to provide recommendations for the first aid of drowning.
In 2019, the American Wilderness Medical Society updated and released a new version of the practice guidelines based on the practice guidelines for the prevention and treatment of acute altitude illness first published in 2010 and updated in 2014. This article interprets the guidelines, focusing on effective measures to prevent and treat different forms of acute altitude illness, as well as suggestions for specific methods to manage the disease, with a view to providing help for clinicians in better practice.
In November 2022, the International Liaison Committee on Resuscitation updated the International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations for the sixth time. The 2022 review includes 21 topics addressed with systematic reviews by the Recovery Task Force of International Liaison Committee on Resuscitation. Among them, there are nine topics related to life support for newborns and children, including public-access defibrillation devices for children, pediatric early warning systems, maintaining normal temperature immediately after birth, suctioning of amniotic fluid at birth, tactile stimulation for resuscitation immediately after birth, use of continuous positive airway pressure for respiratory distress at term birth, respiratory monitoring in the delivery room, heart rate monitoring in the delivery room, and supraglottic airway use in neonates. The Task Force made treatment recommendations for each of the above topics after weighing evidence and discussion. In some cases, good practice statements have been provided for topics thought to be of particular interest to the resuscitation community when the evidence is insufficient to support a recommendation. Good practice statements are not recommendations but represent expert opinion. In order to facilitate the readers to understand the treatment recommendation well, in the recommendation basis part, the basic principle is briefly described. In addition, the existing problems and future research directions of each topic after the systematic reviews are also clearly stated.
ObjectiveTo investigate the influence of sepsis on the expression of apoptotic protease caspase-3 in hippocampus neurons of rats. MethodsModels of rats with sepsis were established by the cecal ligation and puncture (CLP) method. Eighty 30-day-old male Wistar rats were randomly divided into CLP group (n=50) and control group (n=30). In the CLP group, only CLP was performed on the rats. Ten rats in the CLP group and another 10 in the control group were taken at 6, 12, and 24 hours after operation, respectively. Five of them in each group were taken for neurobehavioral score, and the other five were killed and their brains were removed. Then the Western blot and immunohistochemistry staining were used to detect the expression changes of apoptosis protein caspase-3. ResultsIn the control group, there were very low expression of apoptotic protease caspase-3 and high scores of neurological behavior. In the CLP group, the expression of apoptotic protease caspase-3 started to increase at the 6th hour, and reached the peak at the 24th hour after CLP, both of which were significantly higher than the control group (P<0.05). The scores of neurological behavior of the CLP group began to decline at 6h after CLP, and decreased gradually along with the time, and the scores were significantly lower at various time points after CLP in the CLP group than those in the control group (P<0.05). ConclusionThe scores of neurological behavior decrease and the expression of apoptosis protease caspase-3 increase in the rat hippocampus with sepsis, and fluctuate with time change.